Philippines onlyPosition Summary
We are seeking a highly analytical and detail-oriented Certified Professional Coder (CPC) to join our team. This role is highly focused on Denial Management and Revenue Integrity. The ideal candidate is not just a coder but a problem solver who can investigate the root cause of unpaid claims, correct coding errors, and successfully appeal denials.
While this role focuses on coding, candidates with a strong background in hard coding (coding directly from operative reports/medical records without relying solely on encoders) and end-toend medical billing will be given top priority.
Key Responsibilities
Denial Management & Coding
- Analyze and resolve complex claim denials resulting from coding errors (CCI edits, medical necessity, bundling issues, and modifier usage).
- Review medical records and "hard code" accurately from documentation to support appeals, ensuring the highest level of specificity for ICD-10-CM, CPT, and HCPCS levels.
- Draft and submit comprehensive appeal letters to payers, citing appropriate coding guidelines (AMA, CMS) to overturn denials.
- Identify trends in coding denials and provide feedback to the billing team or providers to prevent future rejections.
Billing & Revenue Cycle Support
- Utilize medical billing experience to understand the full lifecycle of a claim, ensuring that corrected codes are entered and rebilled according to payer-specific clearinghouse requirements.
- Verify insurance eligibility and benefits when denials relate to coverage issues.
- Collaborate with the accounts receivable team to ensure timely follow-up on aged claims.
Communication & Inbound Support
- Inbound Call Handling: Handle inbound inquiries from patients regarding billing questions or from insurance representatives regarding claim status.
- Communicate effectively with providers to clarify documentation gaps that lead to coding denials.
Manager or supervisor might assign tasks outside Key responsibilities and Scope of work. These tasks are limited to the purposes under the revenue cycle management.
Qualifications & Requirements
- Certification: Current CPC (Certified Professional Coder) certification through AAPC is required.
- Experience: 2+ years of experience in medical coding is a plus, with a specific focus on working denial buckets.
- Knowledge: Deep understanding of anatomy, physiology, and medical terminology.
- Tech Stack: Proficiency with EMR/EHR systems (e.g., Insert specific software like Epic, eClinicalWorks, NextGen) and clearinghouses.
Preferred Qualifications (The "Advantage")
- Hard Coding Mastery: Proven ability to code manually from the book/documentation without heavy reliance on CAC (Computer-Assisted Coding) software.
- Billing Background: Previous experience in a Medical Biller role (posting payments, scrubbing claims, working AR) is a significant advantage.
- Call Center Experience: Prior experience handling inbound calls in a mid-to-highvolume healthcare or customer service setting is a plus.
Key Competencies (Soft Skills)
- Investigative Mindset: The ability to look at a denied claim like a detective and determine exactly why it was rejected.
- Resilience: Persistence in following up with insurance payers until a resolution is achieved.
- Attention to Detail: Accuracy in reviewing extensive medical charts and payer policies
Kenya only
