PHRN with Certified Inpatient Coder Experience

Optum, a UnitedHealth Group Company; Metro Manila; Hybrid; PHP 350,000 - 550,000; Full time

Benefits offered by this job

Fixed Weekends Off

Pure Non-Voice Account

Market Competitive Pay Levels

Retirement Plan

Medical Plan (HMO) from Day 1

Dental, Medical, and Optical Reimburse

Life and Disability Insurance

Paid Time-Off Benefits

Sick Leave Conversion

Tuition Fee Reimbursement

Employee Assistance Program (EAP)

Annual Merit Increases

Employee Recognition

Training and Staff Development

Employee Referral Program

Volunteerism Opportunity

Job summary

Optum is seeking an Appeals Coder/CV Nurse in the Philippines. The role focuses on reviewing medical records, extracting pertinent details, and crafting persuasive appeal letters while complying with policies.

You’ll manage cases within time goals and maintain high-quality standards to support our patients and providers. Ideal candidates hold an active PHRN license, CPC/CCS/COC/CIC/CRC certification, and at least 3 years of medical coding experience, with inpatient coding preferred.

Qualifications

• Active PHRN license required.
• Active medical coding certification (CPC/CCS/COC/CIC/CRC) required.
• Minimum 3 years medical coding experience; inpatient coding preferred.
• Experience in clinical appeals, utilization management, or denial management is a plus.
• Willing to work on a hybrid set-up at Makati, Alabang or Quezon City sites.

Responsibilities

• Review and extract case details from patient medical records and craft defensible appeal letters per guidelines.
• Complete cases within time expectations while ensuring high-quality reviews and adherence to Optum/OPAS policies.

Skills

PHRN License

CPC/CCS/COC/CIC/CRC

Medical coding experience

Clinical appeals experience

Job description

ROLE AND RESPONSIBILITIES

• The Appeals Coder/CV Nurse will accurately and efficiently review and extract pertinent case details from patient medical records; and craft strongly defensible appeal letters per process instructions and the department’s/company’s guidance.

• The Appeals Coder/CV Nurse will complete their case within the time expectations while providing high quality reviews. The Appeals nurse will perform their job functions, adhering to both Optum and OPAS policies and procedure.

Your role is critical in allowing our members, families, facilities and health professionals to have greater confidence in the exceptional care we provide. And for you, an everyday opportunity to do your life’s best work.

JOB QUALIFICATIONS

• Active PHRN License

• Active medical coding certification such as CPC, CCS, COC, CIC, or CRC

• At least 3 years of medical coding experience; inpatient coding experience is highly preferred

• Experience in clinical appeals, utilization management, or denial management is an advantage

• Willing to work on a hybrid set-up in any of our sites (Makati, Alabang, Quezon City)

WHAT WE OFFER

• Fixed Weekends Off

• Pure Non-Voice Account

• Market Competitive Pay Levels

• Retirement Plan

• Medical Plan (HMO) from Day 1 of employment

• Dental, Medical, and Optical Reimbursements

• Life and Disability Insurance

• Paid Time-Off Benefits

• Sick Leave Conversion

• Tuition Fee Reimbursement

• Employee Assistance Program (EAP)

• Annual Performance Based Merit Increases

• Employee Recognition

• Training and Staff Development

• Employee Referral Program

• Employee Volunteerism Opportunity

• All Mandatory Statutory Benefits

WHO WE ARE

• Optum is the health care technology and innovation company of the UnitedHealth Group enterprise along with UnitedHealthcare.

• UnitedHealth Group is a health care and well-being company with a mission to help people live healthier lives and help make the health system work better for everyone.

• We’re a leading health solution and care delivery organization. Our work is complex, but our mission is simple: create a healthier world, with you at the center.

• As part of a Fortune 5 enterprise, we are improving the health care experience of over 125 million people around the world.

• Elevate your career with a leading health care company while improving lives.

Join us in evolving health care so everyone can have the opportunity to live their healthiest life. This is your opportunity to be part of a team that’s dedicated to Caring. Connecting. Growing together