Claims Coordinator Specialist

Responsibilities:

• - Review diagnosis and medication coding for infusion services, especially when payer limitations apply.

  - 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