Claims Coordinator Specialist

4 weeks ago

Taguig, Philippines Cobden & Carter International Full-time

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Responsibilities:

- Review diagnosis and medication coding for infusion services, especially when payer limitations apply.

- Assess payer medical policies and CMS guidelines to confirm medical necessity and coverage eligibility.

- Ensure clinical documentation aligns correctly with billing codes prior to service delivery.

- Coordinate and verify the completion of Advance Beneficiary Notices (ABNs) in the system, including correct use of modifiers.

- Apply Medicare guidelines and FDA labeling requirements when making coding determinations.

- Work closely with infusion intake, billing, and clinical teams to resolve coding inconsistencies.

- Identify and escalate complex reimbursement or compliance issues when necessary.

- Maintain thorough documentation to support coding decisions and ensure audit readiness.

- Support adherence to regulatory, payer, and organizational billing standards.

- Contribute to process improvement efforts aimed at enhancing coding accuracy and reimbursement outcomes.

Qualifications:

Bachelor's Degree in Health Information Management, Medical Coding, or a related field.
Certification as a Certified Professional Coder (CPC) from the American Academy of Professional Coders (AAPC) or certification from the American Health Information Management Association (AHIMA).
1–3 years of experience in medical coding, healthcare billing, or revenue cycle operations.
On-the-job training in coding systems, payer policies, and internal workflows.

Certified Outpatient Coder (COC) from AAPC.
Certified Hematology and Oncology Coder (CHONC) from AAPC.
3+ years of medical coding or hospital billing experience, including at least 1 year in Hospital Outpatient Department (HOPD) infusion coding.
Advanced training in Medicare billing guidelines and infusion coding practices.
Spanish language skills or proficiency in other languages.

Location: BGC, Taguig

Schedule: Shifting

Work set-up: Full onsite