Claims Coordinator Specialist

- Assess payer medical policies and CMS guidelines to confirm medical necessity and coverage eligibility.

- Ensure clinical documentation aligns correctly with billing codes prior to service delivery.

- Coordinate and verify the completion of Advance Beneficiary Notices (ABNs) in the system, including correct use of modifiers.

- Apply Medicare guidelines and FDA labeling requirements when making coding determinations.

- Work closely with infusion intake, billing, and clinical teams to resolve coding inconsistencies.

- Identify and escalate complex reimbursement or compliance issues when necessary.

- Maintain thorough documentation to support coding decisions and ensure audit readiness.

- Support adherence to regulatory, payer, and organizational billing standards.

- Contribute to process improvement efforts aimed at enhancing coding accuracy and reimbursement outcomes.

Qualifications:

• Bachelor's Degree in Health Information Management, Medical Coding, or a related field.
• Certification as a Certified Professional Coder (CPC) from the American Academy of Professional Coders (AAPC) or certification from the American Health Information Management Association (AHIMA).
• 1–3 years of experience in medical coding, healthcare billing, or revenue cycle operations.
• On-the-job training in coding systems, payer policies, and internal workflows.

Preferred Qualifications

• Certified Outpatient Coder (COC) from AAPC.
• Certified Hematology and Oncology Coder (CHONC) from AAPC.
• 3+ years of medical coding or hospital billing experience, including at least 1 year in Hospital Outpatient Department (HOPD) infusion coding.
• Advanced training in Medicare billing guidelines and infusion coding practices.
• Spanish language skills or proficiency in other languages.

Location: BGC, Taguig

Schedule: Shifting

Work set-up: Full onsite