Audit Technician – Denied Medical Claims

1 day ago

Cebu City, Central Visayas, Philippines Health Business Solutions Full time ₱600,000 - ₱800,000 per year

Position Summary

The Audit Technician for Denied Medical Claims is responsible for reviewing, analyzing, and reconciling denied healthcare claims to ensure accuracy, compliance, and timely resolution. This role supports the appeals and audit process by identifying errors, gathering documentation, and preparing claims for reconsideration. The Audit Tech works closely with auditors, nurses, and claims specialists to minimize financial loss and improve claim acceptance rates.

Key Responsibilities
  • Review denied medical claims to determine reasons for denial (coding errors, missing information, medical necessity, eligibility, etc.).
  • Collect, organize, and verify supporting documentation needed for appeals or audits.
  • Prepare and submit claim audit packets for internal review or external payor reconsideration.
  • Collaborate with clinical staff, coders, and billing teams to resolve discrepancies and correct claim data.
  • Maintain accurate tracking of denied claims, appeals filed, and outcomes for reporting purposes.
  • Identify trends in denials and escalate recurring issues to management for process improvement.
  • Ensure compliance with HIPAA, CMS, and payor guidelines.
  • Assist with internal audits, quality checks, and special projects as assigned.
Qualifications
  • Bachelor's degree in healthcare administration, business, or related field preferred.
  • Minimum 3 years prior experience in medical claims, billing, coding, or auditing..
  • Knowledge of ICD-10, CPT, and HCPCS coding, as well as medical terminology.
  • Familiarity with payor policies, EOBs, and claim adjudication processes.
  • Strong organizational skills with attention to detail and accuracy.
  • Ability to work with confidential patient and claims information in compliance with HIPAA.
  • Proficiency in Microsoft Office Suite and experience with claims management systems (Epic, Facets, Availity, etc. preferred).
Skills & Competencies
  • Analytical thinking and problem-solving
  • Strong written and verbal communication
  • Time management and multitasking
  • Collaboration and teamwork
  • Process improvement mindset

  • Medical Biller – Remote

    1 day ago

    Cebu City, Central Visayas, Philippines Thrive Speech Therapy, PLLC Full time $360,000 - $480,000 per year

    Medical Biller – Remote Thrive Speech Therapy, PLLCAt Thrive Speech Therapy, PLLC, we help children find their voice—and we believe our team should feel equally supported and empowered. With eight clinics across the Houston area and continued plans for growth, Thrive is committed to providing compassionate, personalized therapy services and building a...

  • Medical Transcriptionist

    3 days ago

    Cebu City, Central Visayas, Philippines Southwestern University Medical Center Full time ₱216,000 per year

    Southwestern University Medical Center, a Mount Grace partner and a tertiary general hospital that is committed to providing quality and reliable health services is looking for a detail-oriented MEDICAL TRANSCRIPTIONIST.The primary role of the MEDICAL TRANSCRIPTIONIST is the accurate filling out of PhilHealth CF4 claims form and overall assistance in...

  • medical transcriptionist

    3 days ago

    Cebu City, Central Visayas, Philippines Southwestern University PHINMASouthwestern University Medical Center Full time ₱200,000 - ₱250,000 per year

    Southwestern University Medical Center, a Mount Grace partner and a tertiary general hospital that is committed to providing quality and reliable health services is looking for a detail-oriented MEDICAL TRANSCRIPTIONIST.The primary role of the MEDICAL TRANSCRIPTIONIST is the accurate filling out of PhilHealth CF4 claims form and overall assistance in...

  • Medical Claims Processor

    1 day ago

    Cebu City, Central Visayas, Philippines Equicom Services, Inc. Full time ₱280,000 - ₱400,000 per year

    Equicom Services, Inc. is now looking for Medical Claims Processor who can work onsite.Cebu Office Office: 8F Appleone Equicom Tower Cebu Business Park, Cebu CityQualificationsGraduate of any 4 year medical related courses / Undergrad atleast 3rd year levelOpen for fresh graduatesExcellent oral and written communication skillsAbility to multi-task while...

  • Claims CSR

    3 days ago

    Cebu City, Central Visayas, Philippines JustPressOne, Inc. Full time ₱240,000 - ₱300,000 per year

    We are seeking a proactive and detail-oriented Warranty Contract Administrator to join our growing team. In this role, you will be responsible for processing warranty claims for appliance repair services performed by technicians. You will play a key part in ensuring claims are submitted accurately, authorizations are obtained, payments are tracked, and...

  • Medical Coder

    1 day ago

    Cebu City, Central Visayas, Philippines HRTX Full time ₱250,000 - ₱500,000 per year

    We are looking for a detail-oriented and certified Medical Coder to join our healthcare operations team. The ideal candidate will accurately review, analyze, and assign the appropriate medical codes for diagnoses, procedures, and services rendered in various healthcare settings. This role plays a crucial part in ensuring compliance, accuracy, and efficiency...

  • Tariffs Claim Manager

    3 days ago

    Cebu City, Central Visayas, Philippines Integrated Flow Systems LLC Full time ₱1,200,000 - ₱2,500,000 per year

    Join UCT and be part of the fastest-growing sector in the world We indirectly touch every semiconductor chip that goes into every smartphone, smart car and device that uses artificial intelligence. This is a critical time for the semiconductor industry and for UCT - as technology evolves, we evolve with it. UCT is a diverse workplace where every talented...

  • patient care advocate

    3 days ago

    Cebu City, Central Visayas, Philippines PhilCare Inc. Full time ₱250,000 - ₱500,000 per year

    JOB SUMMARY:The position is essentially responsible in effectively carrying out set strategies of Customer Experience Divisionrelevant to the confinement of valued members. It ensures customer satisfaction through effective rapportand proper utilization management.DUTIES AND RESPONSIBILITIES:1. CUSTOMER EXPERIENCEAlways ensures efficient execution of...

  • Electronic Technician

    3 days ago

    Cebu City, Central Visayas, Philippines ZC KINGS MANPOWER AND JANITORIAL SERVICES COOPERATIVE Full time ₱180,000 - ₱216,000 per year

    An electronic technician designs, installs, maintains, and repairs electronic systems and equipment. They troubleshoot and fix problems in devices like computers, communication equipment, and medical instruments, often working with electrical engineers to ensure systems function correctly.Job Type: Full-timePay: Php15, Php18,000.00 per monthWork Location: In...

  • Biomedical Technician

    1 day ago

    Cebu City, Central Visayas, Philippines OPERATION SMILE PHILS. FOUNDATION INC. Full time

    The Biomedical Technician will play a critical role in ensuring that all medical equipment at the Cebu COE is safe, functional, and aligned with international standards. This position supports surgical missions, training, and daily clinical operations by overseeing the installation, maintenance, calibration, and compliance of biomedical devices.Key...