Denial Management Executive (Ortigas, Alabang, Clark) (Medical Coder)

Ingenious Philippines is hiring! We are looking for Medical Coders to be part of our Denials Management team in Alabang, Ortigas and Clark!

Qualification:

• Must have have an active AAPC or AHIMA License
• Experience in OP coding, Claims, Denial Management
• Profee coding experience
• Amenable to onsite work and night shift

Responsibilities:

• Research payer denials related to referral, pre-authorization, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment. 

• Independently write professional appeal letters. 

• Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare, Medicaid, and third-party guidelines as well as UW Health policies and procedures. 

• Submit retro-authorizations in accordance with payor requirements in response to authorization denials. 

• Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution. 

• Make recommendations for additions/revisions/deletions to work queues and claim edits to improve efficiency and reduce denials.