DRG Nurse Auditor | DRG Coder | PHRN

Private Advertiser; Pasay; On-site; PHP 502,000 - 837,000; Full time

Job summary

Private Advertiser is seeking skilled Inpatient DRG Medical Coders to join our Healthcare BPO team in the Philippines. You will review inpatient records, assign ICD-10-CM/PCS codes, and validate DRG assignments to ensure accurate billing and compliance.

The ideal candidate is a Philippine Registered Nurse with CIC or CCS certification, experienced in inpatient coding, familiar with DRG concepts, and able to work night or shifting schedules while maintaining quality and productivity.

Qualifications

• Must be a Philippine Registered Nurse (PHRN).
• Must have an active CIC (Certified Inpatient Coder) or CCS (Certified Coding Specialist) certification.
• Preferably with experience in inpatient medical coding, DRG validation, clinical documentation review, or healthcare BPO operations.
• Strong knowledge of ICD-10-CM/PCS, DRG/APR-DRG concepts, and inpatient coding guidelines.
• Good understanding of medical terminology, anatomy, physiology, and clinical documentation.
• Strong analytical and critical-thinking skills.
• Excellent written and verbal communication skills.
• Able to work independently while meeting quality and productivity targets.
• Willing to work on shifting schedules, weekends, and holidays as required.
• Willing to work on a night shift or shifting schedule, depending on business requirements.

Responsibilities

• Review inpatient medical records and clinical documentation for accurate coding and DRG assignment.
• Assign ICD-10-CM and ICD-10-PCS codes based on documentation and guidelines.
• Review and validate DRG/APR-DRG assignments.
• Identify documentation gaps, coding discrepancies, and potential reimbursement issues.
• Apply official coding guidelines and payer-specific requirements when applicable.
• Collaborate with physicians, clinical documentation specialists, auditors, and other healthcare professionals.
• Ensure coding accuracy, compliance, and adherence to client and regulatory standards.
• Meet established quality, productivity, and turnaround-time requirements.
• Maintain confidentiality and comply with HIPAA and other applicable healthcare privacy regulations.
• Stay updated on changes to ICD-10-CM, ICD-10-PCS, and official coding guidelines.
• Collaborate with clinical documentation, quality, audit, and operations teams as needed.

Skills

Analytical thinking

Communication skills

Independent work

Night shift availability

Shift flexibility

Education

Philippine Registered Nurse (PHRN)

CIC or CCS certification

Job description

We are looking for skilled Inpatient DRG Medical Coders to join our Healthcare BPO team. You will be responsible for accurately reviewing inpatient medical records and assigning appropriate diagnosis and procedure codes based on official coding guidelines, documentation, and payer requirements.

Key Responsibilities

• Review inpatient medical records and clinical documentation for accurate coding and DRG assignment

• Assign appropriate ICD-10-CM and ICD-10-PCS codes based on documentation and coding guidelines

• Review and validate DRG/APR-DRG assignments

• Identify documentation gaps, coding discrepancies, and potential reimbursement issues

• Apply official coding guidelines and payer-specific requirements when applicable

• Collaborate with physicians, clinical documentation specialists, auditors, and other healthcare professionals

• Ensure coding accuracy, compliance, and adherence to client and regulatory standards

• Meet established quality, productivity, and turnaround-time (TAT) requirements

• Maintain confidentiality and comply with HIPAA and other applicable healthcare privacy regulations

• Stay updated on changes to ICD-10-CM, ICD-10-PCS, official coding guidelines, and healthcare regulations.

• Collaborate with clinical documentation, quality, audit, and operations teams as needed.

Qualification

• Must be a Philippine Registered Nurse (PHRN)

• Must have an active and valid CIC (Certified Inpatient Coder) or CCS (Certified Coding Specialist) certification

• Preferably with experience in inpatient medical coding, DRG validation, clinical documentation review, or healthcare BPO operations

• Strong knowledge of ICD-10-CM/PCS, DRG/APR-DRG concepts, and inpatient coding guidelines

• Good understanding of medical terminology, anatomy, physiology, and clinical documentation

• Strong analytical and critical-thinking skills

• Excellent written and verbal communication skills

• Able to work independently while meeting quality and productivity targets

• Willing to work on shifting schedules, weekends, and holidays as required

• Willing to work on a night shift or shifting schedule, depending on business requirements.