Medical Coder
3 days ago
Position: Medical Coder
Location: 1880 Eastwood, Libis, Quezon City
Work setup & shift: WFH | Night shift
Your Role:
As an Medical Coder, you will:
- Assign accurate CPT, ICD-10-CM, and HCPCS codes for wound care procedures, including debridement, skin grafts, and negative pressure wound therapy (NPWT).
- Ensure full compliance with CMS, HIPAA, and payer-specific regulations to minimize claim denials, audits, and compliance risks.
- Submit and monitor claims for wound care services, identifying and resolving coding or documentation errors to optimize reimbursement.
- Collaborate with physicians, billers, and insurance carriers to resolve denials, appeals, and discrepancies throughout the revenue cycle.
- Review clinical documentation to ensure it supports medical necessity, procedure coding, and payer compliance standards.
- Conduct insurance verification processes, including checking prior authorizations and validating medical necessity.
- Maintain up-to-date knowledge of coding changes, coverage policies, and reimbursement trends relevant to wound care.
- Provide education and training to healthcare providers and staff on accurate coding practices and documentation improvement strategies.
- Utilize coding and billing software (e.g., EncoderPro, 3M) and platforms such as Netsuite, Smartsheet, and ZoHo to manage workflows efficiently.
- Communicate effectively with payers via IVR and other systems to track claim status and resolve outstanding issues.
Non-negotiables:
- Active certification as a Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent.
- Minimum of 2 years of experience in medical billing and coding, with direct experience in wound care coding preferred.
- In-depth understanding of Medicare, Medicaid, and commercial insurance policies specific to wound care.
- Proficiency in EHR/EMR systems, coding software (Encoder Pro, 3M), and Microsoft Office Suite.
- Strong ability to analyze medical records, ensure documentation integrity, and identify coding discrepancies.
- Excellent verbal and written communication skills for collaborating with cross-functional teams.
Preferred skills/experience:
- Experience using modifiers and coding techniques specific to wound care billing.
- Familiarity with Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) for wound care treatments.
- Background in claims audits, appeals, and payer dispute resolution.
- Experience working in Netsuite, Smartsheet, and ZoHo is a plus.
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