Denial Management / Medical Coding Edits Specialist (with 50k SOB)

MED-METRIX INTERNATIONAL PH-I, INC.; Metro Manila; Remote; PHP 350,000 - 550,000; Full time

Benefits offered by this job

8-hour shifts

Fixed weekends off

Day 1 HMO with dependents covered

Medical cash allowance

Rice allowance

Clothing allowance

Paid time off

Training and staff development

Employee engagement activities

Internal mobility opportunities

Job summary

Med-Metrix International PH-I, INC. is seeking a Denials Management Coder responsible for reviewing denied claims for coding errors and applying corrections to CPT/ICD-10 codes, modifiers, and related actions.

The role ensures compliance with government and local guidelines across payers including Medicare, Medicaid, Blue Cross, and commercial carriers. The position requires at least 1 year of coding experience in denials, familiarity with Medicare/Medicaid guidelines, HIPAA/PHI adherence, and

Qualifications

• CPC/COC certification (AAPC) or CCS certification from AHIMA.
• Minimum one year of coding experience related to the specialty (Coding Denials).
• Knowledge in Medicare and Medicaid guidelines preferred.
• Working knowledge of managed care, commercial insurance, Medicare/Medicaid.
• Understanding and adherence to HIPAA and PHI Guidelines.
• Strong interpersonal skills, ability to communicate well at all levels of the organization.
• High level of integrity and dependability with a strong sense of urgency and results oriented.
• Excellent written and verbal communication skills required.
• Documentation and data entry skills.
• Gracious and welcoming personality for customer service interaction.

Responsibilities

• Read and interpret insurance carrier EOBs.
• Review medical reports, verify coding.
• Resolve coding related denial.
• Make any necessary coding corrections.
• Generate replacement claims (electronic and paper)
• Research carrier specific coding policies.
• Review and interpret carrier NCD and LCD policies.
• Communicate any coding denial trends to coding manager.

Skills

CPC/COC (AAPC) or CCS

1 year coding experience

Medicare/Medicaid knowledge

Managed care knowledge

HIPAA/PHI guidelines

Interpersonal skills

Integrity & reliability

Written & verbal communication

Documentation/data entry

Customer service attitude

Job description

Experience these exceptional benefits when you join Med-Metrix!

• 8-Hour Shifts, Fixed Weekends Off


• Day 1 HMO with 2 of your dependents covered for FREE


• Medical Cash Allowance


• Rice Allowance


• Clothing Allowance


• Paid Time Off


• Training and Staff Development


• Employee Engagement Activities


• Opportunities for Internal Mobility

Job Purpose

Responsible for reviewing denied claims for coding related errors and determining appropriate action. The Denials Management Coder will be responsible for corrections to individual accounts with include CPT and/or ICD-10 Corrections, applications of correct modifiers, etc. The coder is also responsible for ensuring that government and local guidelines are followed. Payers include but not limited to Medicare, Medicaid, Blue Cross, and commercial health insurance carriers.

Duties and Responsibilities

• Read and interpret insurance carrier EOBs.


• Review medical reports, verify coding.


• Resolve coding related denial.


• Make any necessary coding corrections.


• Generate replacement claims (electronic and paper)


• Research carrier specific coding policies.


• Review and interpret carrier NCD and LCD policies.


• Communicate any coding denial trends to coding manager.

Qualifications

• CPC/COC certification AAPC or CCS certification from AHIMA


• Minimum one (1) year of coding experience related to the specialty needed (Coding Denials)


• Knowledge in Medicare and Medicaid guidelines preferred.


• Working knowledge of managed care, commercial insurance, Medicare/Medicaid.


• Understanding and adherence to HIPAA and PHI Guidelines.


• Strong interpersonal skills, ability to communicate well at all levels of the organization


• High level of integrity and dependability with a strong sense of urgency and results oriented


• Excellent written and verbal communication skills required


• Documentation and data entry skills


• Gracious and welcoming personality for customer service interaction

Working Conditions

• Work Set-Up: Work From Home


• Work Schedule: Dayshift; must be flexible to accommodate changing business needs.


• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.


• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.


• Work Environment: The noise level in the work environment is usually minimal.