Nurse Appeals Coder

As a Nurse Appeals Coder, you will review and analyze medical records, clinical documentation, coding information, and denied healthcare claims to determine the accuracy and validity of coding and medical necessity. Combining your clinical nursing expertise and medical coding knowledge, you will support the preparation of accurate, well-supported appeals while collaborating closely with clinical, coding, and appeals teams.

Salary: ₱40,000–₱45,000 Basic Salary, ₱8,000 PHRN Allowance and ₱7,000 Complexity Allowance.

Additional Perks: Premium HMO + free dependents, life insurance & retirement fund package!

Work Setup:

• Hybrid setup in Quezon City
• Hybrid setup in Makati
• Hybrid setup in Muntinlupa

Responsibilities

• Review denied healthcare claims, medical records, and clinical documentation to determine the reason for denial and establish medical necessity.
• Validate diagnosis and procedure codes against clinical documentation, research payer policies, and prepare clear, well-supported appeal documentation.
• Collaborate with coding, clinical, utilization management, and appeals teams to resolve discrepancies and handle complex cases.
• Maintain accuracy, productivity, and quality standards while adhering to HIPAA, data privacy regulations, and established turnaround times.

Qualifications

• Bachelor’s Degree in Nursing with an active PHRN License.
• Active coding certification such as CCS, CCS-P, CPC-H, CPC, RHIT, RHIA, CDIP, or CCDS.
• At least 3 years of clinical/bedside nursing experience from a tertiary or secondary hospital (within the last 5 years) in areas such as ICU, CCU, Telemetry, CVICU, MICU, ER, or Medical-Surgical (MS).
• At least 2 years of medical coding experience.
• Strong understanding of medical terminology, anatomy, physiology, and clinical coding principles, with willingness to work on a shifting schedule.