Medical Coder - CPC and PHRN

Cotiviti Philippines Inc; Metro Manila; On-site; PHP 300,000 - 540,000; Full time

Job summary

Cotiviti Philippines Inc is seeking a Clinical Analyst to apply medical coding expertise to ensure precise reimbursement across a growing client base. The role combines clinical coding with auditing, denial management, and policy knowledge to assign codes per CMS and payer requirements.

Ideal candidates have 1 year in medical coding, CPC certification, and a nursing or allied sciences background. This onsite Manila position requires a proactive, quality-driven professional ready to participate

Qualifications

• Minimum 1 year of medical coding experience.
• Knowledge of E/M and denial management.
• Familiarity with CMS, Medicaid regulations, ICD-10, CPT, HCPCS.

Responsibilities

• Perform daily audits on client data for coding accuracy and completeness.
• Respond to provider appeals and client logics.
• Monitor acceptance rates and flag negative deviations.
• Provide feedback to management on edits to improve efficiency.
• Report performance to team lead and meet productivity/quality targets.
• Engage in ongoing learning and development.

Skills

Medical coding

US healthcare claims processing

Denial management

CMS/Medicaid policies

ICD-10 CPT HCPCS knowledge

Education

Bachelor's degree in Allied Sciences

CPC certification

Registered Nurse

Job description

We are currently seeking Clinical Analyst to support a growing client base while combining their clinical and/or coding expertise with payment accuracy. The Clinical Analyst 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.
• Contribute to PCI product by providing feedback to Management/Development Teams on changes to enhance editing and efficiency.
• 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

RELEVANT EXPERIENCE & EDUCATIONAL REQUIREMENTS:

• 1 years of experience in medical coding / US healthcare claims processing
• Experience with E&M and Denial Management
• Possesses knowledge of healthcare claims payment policy and processing –
• specifically, CMS, Medicaid regulations, AAOS, ICD-10, CPT & HCPCS, etc.
• Registered Nurse with CPC/COC certification or Bachelor's Degree from Allied Sciences with CPC certification
• Must be willing to work onsite

Office Location:

• Manila: Cotiviti Office located at 15th Floor, Robinsons Cyberscape Gamma, Topaz Rd, Ortigas Center, Pasig