Claims Expert

Company : Cobden & Carter International

Job Type : Full Time

Taguig Metro Manila Philippines

Number of Applicants

000+

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Job Description - Claims Expert

Responsibilities:

- Review and validate diagnosis and medication coding for infusion services, with a focus on payer-specific requirements and restrictions, serving as the primary resource for complex or non-standard cases.

- Analyze payer medical policies and CMS guidelines to determine coverage eligibility and medical necessity, providing expert interpretation in ambiguous or evolving policy situations.

- Ensure clinical documentation is accurately aligned with billing and coding requirements before services are rendered.

- Oversee the completion and validation of Advance Beneficiary Notices (ABNs), ensuring appropriate modifier usage and system documentation.

- Apply advanced knowledge of Medicare regulations and FDA-approved indications to support coding decisions, independently addressing exceptions, denials, and off-label coverage scenarios.

- Partner with infusion intake, billing, and clinical teams to resolve coding inconsistencies and recommend corrective documentation practices.

- Investigate, prioritize, and resolve complex reimbursement and compliance issues, escalating concerns only when regulatory or systemic risks are identified.

- Maintain comprehensive and audit-ready documentation to support coding determinations, compliance reviews, and post-payment audits.

- Ensure adherence to regulatory requirements, payer guidelines, and organizational billing policies.

- Contribute to process improvement initiatives aimed at enhancing coding accuracy, maximizing reimbursement, and standardizing intake workflows.

- Train and onboard new Claims Coordinators on systems, procedures, and industry best practices, while providing ongoing mentorship and operational support to team members.

Qualifications:

- Bachelor's Degree: Specialty/Major: Nursing, Health Information Management, Medical Coding, or related field

- Active Certified Professional Coder (CPC) - American Academy of Professional Coders or American Health Information Management
Association (AHIMA); Active Philippine Registered Nurse (PHRN)
- 3+ years of experience in medical coding, healthcare billing, or revenue cycle
- Trained in coding systems, payer policies, and internal workflows

Location: BGC, Taguig

Work set-up: Full onsite

Schedule: Shifting

Original job Claims Expert posted on GrabJobs ©. To flag any issues with this job please use the Report Job button on GrabJobs.

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Claims Expert

Job Description - Claims Expert

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