Audit Technician – Denied Medical Claims

2 days ago

Manila, National Capital Region, Philippines Health Business Solutions Full time ₱1,200,000 - ₱2,400,000 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

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