Senior Medical Coder(with FWA experience) WFH/DAYSHIFT

5 days ago

Pasig, National Capital Region, Philippines Seven Seven Global Services, Inc. Full time ₱1,200,000 - ₱2,400,000 per year

Responsibilities:

  • Team's point of contact for the given market for clients as well as AH product team
  • Potential to actively contribute, guide and review a small coding team of 2 to 5 people
  • Operate quite independently as an individual contributor.
  • Perform reviews on others work
  • Performing validations in addition to the contributing to underlying delivery
  • Perform broader assessments on the landscape to assess viability of assets/rules/benefits/coding in certain markets and data
  • Creation & maintenance of clinical & operational rules for fraud waste and abuse (FWA) for health insurance
  • Research of international and local APAC trends in FWA and available guidelines that are standard in the industry
  • Creation & validation of Code value sets/ Concepts/ Reference lists for claims processing, benefit rules and billing schedule list

Qualifications
- At least 7 years of relevant experience
- Experience in Rules & Benefits Development (FWA detection, claims processing, billing schedules)
- Experience Reference Data Management (Value sets, Concepts, Reference lists)
- Experience Data Validation & Review (audits, peer review, quality checks)
- Experience Research & Trend Analysis (APAC & global FWA guidelines, coding standards)
- Experience Team Leadership & Guidance (mentoring, small team management, client point of contact)
- Experience Stakeholder Engagement & Communication (cross-functional collaboration, reporting)
- Experience in landscape assessments for viability of assets/rules/benefits/coding in markets & data
- Medical Coder Certification

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