Appeals Coder/CV Nurse – Inpatient Coding (Hybrid)

Optum, a UnitedHealth Group Company; Metro Manila; Hybrid; PHP 350,000 - 550,000; Full time

Benefits offered by this job

Fixed Weekends Off

Pure Non-Voice Account

Market Competitive Pay Levels

Retirement Plan

Medical Plan (HMO) from Day 1

Dental, Medical, and Optical Reimburse

Life and Disability Insurance

Paid Time-Off Benefits

Sick Leave Conversion

Tuition Fee Reimbursement

Employee Assistance Program (EAP)

Annual Merit Increases

Employee Recognition

Training and Staff Development

Employee Referral Program

Volunteerism Opportunity

Job summary

Optum is seeking an Appeals Coder/CV Nurse in the Philippines. The role focuses on reviewing medical records, extracting pertinent details, and crafting persuasive appeal letters while complying with policies.

You’ll manage cases within time goals and maintain high-quality standards to support our patients and providers. Ideal candidates hold an active PHRN license, CPC/CCS/COC/CIC/CRC certification, and at least 3 years of medical coding experience, with inpatient coding preferred.

Qualifications

• Active PHRN license required.
• Active medical coding certification (CPC/CCS/COC/CIC/CRC) required.
• Minimum 3 years medical coding experience; inpatient coding preferred.
• Experience in clinical appeals, utilization management, or denial management is a plus.
• Willing to work on a hybrid set-up at Makati, Alabang or Quezon City sites.

Responsibilities

• Review and extract case details from patient medical records and craft defensible appeal letters per guidelines.
• Complete cases within time expectations while ensuring high-quality reviews and adherence to Optum/OPAS policies.

Skills

PHRN License

CPC/CCS/COC/CIC/CRC

Medical coding experience

Clinical appeals experience

Job description

Optum is seeking an Appeals Coder/CV Nurse in the Philippines. The role focuses on reviewing medical records, extracting pertinent details, and crafting persuasive appeal letters while complying with policies.

You’ll manage cases within time goals and maintain high-quality standards to support our patients and providers. Ideal candidates hold an active PHRN license, CPC/CCS/COC/CIC/CRC certification, and at least 3 years of medical coding experience, with inpatient coding preferred.