Revenue Cycle Denials/Clinical/Coding Quality Auditor

Health Business Solutions LLC; Pasig; On-site; PHP 390,600 - 558,000; Full time

Job summary

Health Business Solutions LLC is looking for a Revenue Cycle Denials / Clinical Coding Quality Auditor in Pasig, Philippines. The role involves performing audits to ensure quality in denial work, validating compliance, and tracking trends for process improvements.

Ideal candidates will have 2+ years in revenue cycle or coding, with a strong understanding of payer rules. Clinical nursing and Epic experience are preferred. This position plays a vital role in enhancing quality across the denials team.

Qualifications

• 2+ years of experience in revenue cycle, denials, coding, billing, or insurance follow-up.
• Coding experience (CPC/CCS a plus).
• Clinical nursing experience.
• Epic experience preferred.
• Strong knowledge of payer rules, denials, and appeal processes.

Responsibilities

• Perform routine audits of denial work, including root cause identification, appeal accuracy, and documentation quality.
• Validate compliance with payer guidelines and internal workflows.
• Provide clear, constructive feedback and assist with training needs.
• Track quality trends and support process improvement initiatives.
• Review Epic account documentation to ensure correct handling and resolution.

Skills

Detail-oriented

Excellent communication skills

Analytical skills

Job description

Summary:

Revenue Cycle Denials / Clinical Coding Quality Auditor identifies training opportunities, and supports continuous quality improvement across the denials team.

Key Responsibilities:

• Perform routine audits of denial work, including root cause identification, appeal accuracy, and documentation quality
• Validate compliance with payer guidelines and internal workflows
• Provide clear, constructive feedback and assist with training needs
• Track quality trends and support process improvement initiatives
• Review Epic account documentation to ensure correct handling and resolution

Qualifications:

• 2+ years of experience in revenue cycle, denials, coding, billing, or insurance follow-up
• Coding experience (CPC/CCS a plus)
• Clinical nursing experience
• Epic experience preferred
• Strong knowledge of payer rules, denials, and appeal processes
• Detail-oriented with excellent communication and analytical skills

Preferred Skills:

• Experience performing quality audits
• Understanding of medical terminology and coding concepts