Onsite Healthcare Quality Auditor: ICD-10 & Claims

Carelon Global Solutions Philippines; Philippines; On-site; PHP 360,000 - 540,000; Full time

Job summary

Carelon Global Solutions Philippines is seeking a Quality Audit professional to evaluate the quality of services and interactions across enrollment, billing, and claims processing. The role requires RN licensure, 3+ years in quality auditing, and expertise in medical coding and ICD-10 terminology, with a 100% onsite work arrangement.

Responsibilities include auditing transactions, reporting issues, tracking trends, and generating audit reports for clients and management.

Qualifications

• Active PHRN license required.
• Minimum of 3 years relevant work experience, including at least 1 year in a Quality Audit role.
• Experience in Medical Coding, Chart Review, and Chart Auditing.
• Strong knowledge of ICD-10 coding standards, medical terminology, and healthcare documentation requirements.
• Willing to work 100% onsite.

Responsibilities

• Evaluates the quality and accuracy of transactions and/or communications with providers, groups, and/or policyholders.
• Identifies, documents, and reports any transaction errors or communications issues in a timely manner to ensure prompt resolution.
• Tracks and trends audit results, providing feedback to management.
• Generates monthly reports of audit findings and supports clients with issues identified.
• Produces other ad hoc reports as requested by internal and external clients.

Skills

Quality auditing

Medical coding

Chart review

ICD-10 knowledge

Auditing reports

Healthcare terminology

Insurance & claims

Problem solving

Onsite availability

Education

BA/BS degree

Job description

Carelon Global Solutions Philippines is seeking a Quality Audit professional to evaluate the quality of services and interactions across enrollment, billing, and claims processing. The role requires RN licensure, 3+ years in quality auditing, and expertise in medical coding and ICD-10 terminology, with a 100% onsite work arrangement.

Responsibilities include auditing transactions, reporting issues, tracking trends, and generating audit reports for clients and management.