Medical Coder  

Position Overview

The Medical Coder will be responsible for reviewing denied claims for coding and/or billing errors and determining appropriate action. The coder will be responsible for corrections to individual accounts which include CPT and/or ICD 10 correction, application of correct modifiers, etc. The Medical Coder is also responsible for ensuring that government, state, and local guidelines are followed. Payers include but are not limited to Medicare, Medicaid, Blue Cross, and commercial health insurance carriers

Role Responsibilities

• Examining medical claims
• Verification of health insurance benefits
• Performing reviews of denied claims (coding and billing) to detect any coding errors and applying appropriate action. CPT, diagnosis, modifier updates.
• Ensure coding guidelines are followed (AMA, Medicare, Medicaid, and private payers).
• Review medical records to verify and substantiate diagnosis and procedures.
• Correcting and resubmitting claims
• Documenting actions taken
• Maintaining quality customer services
• Ensuring legal compliance

• 1-5 Years’ Experience in Revenue Cycle Management and Certification Billing/Coding.
• CPC or equivalent certification. (AAPC/AHIMA)(CPC-A accepted)
• Prior coding experience preferred
• Knowledge of Medicaid/Medicare guidelines preferred
• Working knowledge of managed care, commercial insurance, Medicare/Medicaid
• Understanding and adherence to HIPAA and PHI guidelines
• Comprehensive knowledge of insurance plans, member eligibility, and medical billing
• Understanding of CPT, ICD-10, UB, HCFA, and 837 terminologies
• Excellent interpersonal and customer service skills
• Detail oriented, strong problem solving, analyzing information and research skills
• Excellent math, verbal and communication skills
• Computer proficiency; experience with financial software,
• Documentation and data entry skills
• Ability to meet productivity goals based on portfolio
• Experience level will be confirmed at the time of hiring based upon factors set forth by the company
• Permanent day shift account but the training will be done in the graveyard shift
• Must be willing to work in the office located at Bonifacio Global City, Taguig City