Audit Technician – Denied Medical Claims

Health Business Solutions LLC; Cebu City; On-site; PHP 334,800 - 502,200; Full time

Job summary

A healthcare solutions company based in Cebu City is seeking a qualified candidate for a medical claims auditor role. You will review denied claims, prepare documentation for appeals, and collaborate with clinical and billing teams. The ideal applicant will have a Bachelor's degree in healthcare administration and at least 3 years of relevant experience. Proficiency in coding and compliance with HIPAA regulations is essential. This position offers an opportunity to enhance claims processing efficiency in a supportive environment.

Qualifications

• Minimum of 3 years experience in medical claims, billing, coding, or auditing.
• Knowledge of ICD-10, CPT, and HCPCS coding.
• Ability to work with confidential patient and claims information in compliance with HIPAA.

Responsibilities

• Review denied medical claims to determine reasons for denial.
• Collect and verify supporting documentation for appeals.
• Prepare and submit claim audit packets for review.

Skills

Analytical thinking

Strong written and verbal communication

Time management

Multitasking

Collaboration

Process improvement mindset

Education

Bachelor's degree in healthcare administration or related field

Tools

Microsoft Office Suite

Claims management systems (Epic, Facets, Availity)

Job description

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 audit.
• Prepare and submit claim audit packets for internal review or external payer 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 elevate recurring issues to management for process improvement.
• Ensure compliance with HIPAA, CMS, and payer 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 of 3 years prior experience in medical claims, billing, coding, or auditing highly desirable.
• Knowledge of ICD-10, CPT, and HCPCS coding, as well as medical terminology.
• Familiarity with payer 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.