Medical Coder (CIC/CCS, PHRN)

Cotiviti Philippines Inc; Manila; On-site; PHP 400,000 - 700,000; Full time

Job summary

Cotiviti Philippines Inc. invites applications for Auditor to support a growing client base by applying clinical and coding expertise to ensure accurate descriptions and correct reimbursements.

The Auditor will perform daily data audits, respond to appeals, collaborate with the India team, and participate in training that aligns with US working hours before shifts overlap Philippines time.

Qualifications

• Strong analytical, critical thinking and problem-solving skills.
• Excellent verbal and written communication skills.
• Be a quick learner and proficient in application of learnings.
• Strong organizational skills and adaptability to changing priorities.
• Ability to work independently with focused attention to detail.

Responsibilities

• Perform daily audits on client data for completeness and accuracy of coding.
• Respond to provider appeals and client logics/record reviews.
• Monitor acceptance rates and assist management to detect deviations.
• Report work performance timely to team lead; maintain productivity/quality.
• Engage in ongoing learning and development and attend trainings.
• Work US hours during training (8–12 weeks) and overlap with US hours afterward.
• Required to work from office and coordinate with India team.

Skills

Analytical thinking

Verbal & written communication

Quick learner

Organizational skills

Independent worker

Education

Registered Nurse with CIC/CCS

Tools

Microsoft Word

Excel

PowerPoint

Outlook

Job description

We are currently seeking Auditor to support a growing client base while combining their clinical and/or coding expertise with payment accuracy. The Auditor is responsible for analyzing and interpreting and assign the correct codes for the descriptions available on various medical procedures and diagnosis and other related medical coding as per the medical policy requirements.

• Perform daily audits on client data for completeness and accuracy of coding utilizing both coding and clinical background to ensure appropriateness for reimbursement
• Respond to provider appeals
• Respond to client logics and record reviews
• Monitor acceptance rates for assigned clients and assist management in proactively detecting negative deviations
• Reports his/her work performance on a timely basis to the team lead
• Works diligently to meet and exceed productivity and quality benchmarks
• Takes charge of ongoing learning and development and participates in relevant training and development activities
• Willing to work in US hours during training, which may last for 8 to 12 weeks. Thereafter shift timing will overlap US working hours for couple of hours (shift timing anytime between 9:00am - 1:30am Philippines time), based on business requirements
• Required to work from office
• Works effectively in co-ordination with India team

Attributes and Behaviors:

• Develops and maintains positive working relationships with others
• Shares ideas and information Ability to collaborate efficiently.
• Takes pride in the achievement of team objectives
• Has credibility with peers and senior managers
• Self-motivated - driven to achieve results
• Works with a sense of urgency
• High customer service ethic - is passionate about meeting customer expectations and improving service levels
• Keeps pace with change - acquires knowledge/skills as the business evolves
• Handles confidential information with sensitivity.

Skills and competencies:

• Strong analytical, critical thinking and problem-solving skills
• Excellent verbal and written communication skills
• Be a quick learner and proficient in application of learnings
• Strong organizational skills and adaptive capacity for rapidly changing priorities and workloads
• Ability to work well independently and maintain focus on a topic for prolonged periods of time

Experience requirements:

• Registered Nurses) with CIC/CCS certification and prior auditing/DRG experience preferred
• Experience in US Healthcare, medical coding, medical billing, RCM health plan operations strongly preferred.
• Possesses knowledge of healthcare claims payment policy and processing - specifically CMS, Medicaid regulations, ICD-10 CM & DRG Expert, etc.
• Practical clinical experience working in a hospital/office or nursing home strongly preferred
• Has general knowledge of medical procedures, conditions, illnesses, and treatment practices
• Possesses excellent written and verbal communication skills. Ability to think logically and process sequentially with a high level of detailed accuracy and efficiency
• Has excellent personal computer skills in Microsoft Word, Excel, PowerPoint, Outlook, etc
• Exhibit behavior consistent with Cotiviti Values