Coding denial spe CialistHCM Nexus

Coding Denial Specialist reviews the clinical documentation comprehensively. Writes effective appeal using pertinent and relevant clinical documentation from the medical record which is compliant with industry clinical guidelines. 1. Performs medical record reviews retrospectively and be able to determine why cases are denied and whether an appeal is required. Able to review clinical denials in a timely manner and appropriately utilizing clinical criteria sets. 2. Able to think critically and able to use clinical judgment in providing effective and well-supported appeals. 3. Maintains thorough and current knowledge in clinical expertise and stay relevant to in the fast changing trends in healthcare, reimbursement methodologies and utilization. 4. Able to read and understand medical abstract information from handwritten to type written medical record. 5. Able to observe specific payer guidelines for appeal submission and ensures compliance to law and regulations. Required Qualifications: Certified Medical Coder (ahima/aapc) Must have at least 1 year of Inpatient Coding experience Preferably nursing graduate Preferably with two 1 year of clinical appeals experience BPO experience specifically in healthcare information management account is a plus Excellent English written communication skills Willing to work full-time with shifting schedule / graveyard Temporary work from home - tools provided Willing to work in Ortigas
HCM Nexus

Pasig City, Metro Manila
Temporary
Full-time