Outpatient QA Reviewer - Elevate Coding Quality, HMO Day 1

R1 RCM, Inc.; Metro Manila; On-site; PHP 600,000 - 900,000; Full time

Benefits offered by this job

Health Insurance (HMO on Day 1)

Competitive pay

Professional development opportunities

Job summary

R1 RCM PHILIPPINES, INC. seeks a Quality Reviewer to conduct internal quality reviews across medical coding specialties, improving accuracy and efficiency. You will educate coders, resolve coding issues, and support improvement initiatives while staying current with coding guidelines and payer policies.

The role emphasizes mentoring, identifying gaps, and driving education programs to ensure compliance and high performance in outpatient Profee coding.

Qualifications

• At least 5 years of total work experience in medical coding for outpatient Profee settings with exposure to multiple specialties (coding or auditing for Profee (E/M IP & E/M OP)
• At least 1 year of experience as a quality auditor is preferred.
• License/Certifications: Currently holds and maintains at least 1 role-related certification (CPC, COC, CCS, CCS-P for outpatient roles, CPMA for auditing role).
• Education – Bachelor’s degree in a medical allied course is preferred. For other courses, a high level of knowledge and relevant work experience to illustrate capability.

Responsibilities

• Conduct internal quality reviews across medical coding specialties to assess coder performance and coding accuracy.
• Identify areas for improvement, enhance coding efficiency, and provide educational opportunities.
• Assist in educating coders, resolving coding issues, and driving improvement initiatives.
• Stay up to date with official coding guidelines and payer policies.

Skills

Medical coding

Auditing

Quality review

Education training

Education

Bachelor’s degree in medical allied course

Job description

R1 RCM PHILIPPINES, INC. seeks a Quality Reviewer to conduct internal quality reviews across medical coding specialties, improving accuracy and efficiency. You will educate coders, resolve coding issues, and support improvement initiatives while staying current with coding guidelines and payer policies.

The role emphasizes mentoring, identifying gaps, and driving education programs to ensure compliance and high performance in outpatient Profee coding.