Clinical Appeals RN & Medical Coder

UnitedHealth Group; Makati; On-site; Confidential; Full time

Job summary

UnitedHealth Group’s Optum unit seeks an Appeals Coder/CV Nurse to review patient records and prepare strong, defensible appeal letters following established guidelines. This role combines clinical expertise with precise documentation to support optimal health outcomes.

The ideal candidate holds a nursing degree with an active PHRN license and coding experience, is comfortable working onsite in Metro Manila, and can meet speed and accuracy targets while upholding Optum and OPAS policies.

Qualifications

• Bachelor's degree in nursing, PHRN license and active certification.
• 3+ years of bedside/critical care nursing in tertiary/secondary hospitals (ICU/CCU/ER).
• 1+ year of coding experience and willingness to report onsite.

Responsibilities

• Review patient medical records and extract pertinent details.
• Craft strongly defensible appeal letters per process instructions.
• Complete cases within the specified time with high-quality reviews.

Skills

Critical care experience

Bedside nursing

Coding experience

Education

Bachelor's degree in nursing

PHRN Active License

Active Certification

Job description

UnitedHealth Group’s Optum unit seeks an Appeals Coder/CV Nurse to review patient records and prepare strong, defensible appeal letters following established guidelines. This role combines clinical expertise with precise documentation to support optimal health outcomes.

The ideal candidate holds a nursing degree with an active PHRN license and coding experience, is comfortable working onsite in Metro Manila, and can meet speed and accuracy targets while upholding Optum and OPAS policies.