Home Health Medical Coding QA Specialist

Pointwest Technologies Corporation; Quezon City; On-site; PHP 669,600 - 892,800; Full time

Job summary

A healthcare technology company in Quezon City is seeking a detail-oriented Quality Control for Coding Specialist. The role ensures accuracy and compliance in medical coding and billing, crucial for maintaining health data integrity. Responsibilities include performing internal audits, coding accuracy checks, and supporting revenue cycle optimization. Ideal candidates should have a relevant degree, CPC certification, and 2-3 years of experience in medical coding. Join us to redefine healthcare excellence and be part of a culture committed to quality and continuous improvement.

Qualifications

• 2–3 years’ experience in medical coding and quality control.
• Proficiency with ICD-10, CPT, HCPCS, CMS, and payer-specific guidelines.
• Strong analytical, communication, and collaboration skills.

Responsibilities

• Ensure coding accuracy using ICD-10, CPT, and applicable guidelines.
• Perform internal audits and peer reviews.
• Support revenue cycle optimization through timely audits.
• Provide feedback and coaching to coding team members.

Skills

ICD-10 coding

CPT coding

Analytical skills

Communication skills

Collaboration

Quality control

Education

Degree in Health Information Management, Nursing, or related field

Certified Professional Coder (CPC), CCS or equivalent

Tools

Medical coding software

Audit platforms

Job description

Overview

We are looking for a detail-oriented Quality Control for Coding Specialist to ensure the accuracy, compliance, and consistency of medical coding and billing practices. This role plays a vital part in maintaining the integrity of health data and optimizing the revenue cycle by implementing internal audits, reviews, feedback processes, and continuous improvement initiatives. You’ll be part of a team committed to Leadership, Excellence, Innovation, and a culture of Agility, Accountability, Collaboration, and Customer Centricity.

Key Responsibilities

• Delighting Our Customers & Stakeholders
  • Ensure coding accuracy using ICD-10, CPT, and applicable guidelines
  • Perform internal audits and peer reviews
  • Validate clinical documentation supports coded entries
  • Enforce compliance with HIPAA and payer requirements

• Growing Our Business
  • Reduce coding-related denials and rejections
  • Support revenue cycle optimization through timely audits
  • Recommend process enhancements and tools for better accuracy
  • Contribute insights to client engagement and support activities

• Improving the Way We Work
  • Use audit tools and QC platforms to automate checks
  • Maintain and update audit protocols and workflows
  • Analyze data trends to address recurring issues
  • Collaborate across departments for process alignment

• Developing Myself and Others
  • Provide feedback and coaching to coding team members
  • Lead or join training sessions on compliance and coding standards
  • Stay updated on industry guidelines and certifications
  • Promote a quality-first, learning-driven culture

Key Metrics

• ≥ 95% coding accuracy rate
• ≥ 90% clean claims rate
• ≤ 5% documentation-related coding error rate
• ≥ 20% YOY reduction in coding-related denials
• ≥ 90% adherence to QC protocols and audit schedules
• ≥ 2 professional development activities per year

Qualifications

• Degree in Health Information Management, Nursing, or related field
• Certified Professional Coder (CPC), CCS, or equivalent
• 2–3 years’ experience in medical coding and quality control
• Knowledge of ICD-10, CPT, HCPCS, CMS, and payer-specific guidelines
• Proficiency in medical coding software and audit platforms
• Strong analytical, communication, and collaboration skills

Join us in redefining healthcare excellence—one accurate code at a time. Apply now and be part of a team committed to quality, innovation, and continuous improvement.