Nurse Appeals Coder: Hybrid Medical Claims Specialist

Stark Asia Solutions Inc.; Makati; Hybrid; PHP 446,000 - 502,000; Full time

Benefits offered by this job

Premium HMO + free dependents

Life insurance

Retirement fund package

Job summary

Stark Asia Solutions Inc. is seeking a Nurse Appeals Coder to review denied healthcare claims, analyze medical records, and prepare well-supported appeals.

You will combine nursing expertise with coding knowledge while collaborating with clinical, coding, and appeals teams. You will ensure medical necessity and accuracy, adhere to privacy standards, and work on a shifting schedule in a hybrid setup across Quezon City, Makati, or Muntinlupa.

Qualifications

• Bachelor’s Degree in Nursing with active PHRN License.
• Active coding certification such as CCS, CCS-P, CPC-H, CPC, RHIT, RHIA, CDIP, or CCDS.
• 3+ years of clinical nursing experience in a tertiary or secondary hospital (within the last 5 years) in ICU/CCU/Telemetry/CVICU/MICU/ER/MS.
• At least 2 years of medical coding experience.
• Strong understanding of medical terminology, anatomy, physiology, and clinical coding principles.

Responsibilities

• Review denied healthcare claims, medical records, and clinical documentation to determine the reason for denial and establish medical necessity.
• Validate diagnosis and procedure codes against clinical documentation, research payer policies, and prepare clear, well-supported appeal documentation.
• Collaborate with coding, clinical, utilization management, and appeals teams to resolve discrepancies and handle complex cases.
• Maintain accuracy, productivity, and quality standards while adhering to HIPAA, data privacy regulations, and established turnaround times.

Skills

Medical coding

Nursing experience

Clinical documentation review

HIPAA compliance

Education

Bachelor’s Degree in Nursing

Active PHRN License

CCS/CCS-P/CPC-H/CPC/RHIT/RHIA/CDIP/CCDS certifications

Job description

Stark Asia Solutions Inc. is seeking a Nurse Appeals Coder to review denied healthcare claims, analyze medical records, and prepare well-supported appeals.

You will combine nursing expertise with coding knowledge while collaborating with clinical, coding, and appeals teams. You will ensure medical necessity and accuracy, adhere to privacy standards, and work on a shifting schedule in a hybrid setup across Quezon City, Makati, or Muntinlupa.