Audit Technician Denied Medical Claims

Health Business Solutions LLC; Pasig; On-site; PHP 334,800 - 446,400; Full time

Job summary

A healthcare solutions company is seeking a skilled medical claims auditor in Metro Manila, Philippines. In this role, you will review denied claims, collect necessary documentation, and collaborate with various teams to ensure accurate processing and compliance with regulations. Candidates should have a bachelor's degree, at least 3 years of experience in medical claims, and strong organizational skills. Proficiency in Microsoft Office and familiarity with claims management systems are also essential.

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 for reasons like coding errors and eligibility.
• Collect and verify documentation needed for appeals or audits.
• Collaborate with clinical staff and billing teams to correct claim data.
• Identify trends in denials and escalate issues for process improvement.

Skills

Analytical thinking and problem-solving

Strong written and verbal communication

Time management and multitasking

Collaboration and teamwork

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 audits.
• Prepare and submit claim audit packets for internal review or external payor 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 escalate recurring issues to management for process improvement.
• Ensure compliance with HIPAA, CMS, and payor 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 payor 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