Deskripsi Pekerjaan
Are you an expert in medical coding with a sharp eye for clinical documentation? Sales Rain BPO Inc. is seeking a dedicated Inpatient Coding Appeals Specialist to join our expanding healthcare operations team in Cebu City. In this pivotal role, you will be responsible for meticulously reviewing inpatient medical records to ensure accurate validation of principal diagnoses, secondary diagnoses (CC/MCC), procedures, and DRG assignments.
As an Appeals Specialist, you will act as a bridge between clinical documentation and reimbursement accuracy. You will analyze complex medical charts, identify discrepancies in coding, and draft persuasive clinical appeals to insurance providers. Your expertise will directly impact the financial health of our healthcare partners while ensuring compliance with industry standards and regulatory requirements. If you are passionate about medical auditing and thrive in a fast-paced BPO environment, we want to hear from you!
Tanggung Jawab
- Perform thorough audits of inpatient medical records to validate DRG assignments and clinical documentation.
- Identify and challenge coding inaccuracies by reviewing principal and secondary diagnoses (CC/MCC).
- Draft and submit evidence-based clinical appeals to payers to overturn denials and secure appropriate reimbursement.
- Collaborate with internal coding teams and clinical staff to improve documentation quality.
- Maintain current knowledge of ICD-10-CM/PCS and CPT coding guidelines.
- Ensure all activities remain strictly compliant with HIPAA and other healthcare data privacy regulations.
- Monitor denial trends and provide actionable feedback to mitigate future payment issues.
Kualifikasi
- Bachelor’s degree in Nursing, Health Information Management, or a related healthcare field.
- Active Professional Coder certification (e.g., CCS, CPC, or RHIT/RHIA).
- Minimum of 2-3 years of experience in inpatient medical coding or clinical documentation improvement (CDI).
- Strong knowledge of DRG methodology and coding compliance guidelines.
- Excellent command of English with superior technical writing and analytical skills.
- Proficiency in using Electronic Health Record (EHR) systems and industry-standard coding software.
- Ability to work independently while meeting strict production and quality benchmarks.