6 jobs in Cotiviti Philippines Inc

PRINCIPLE PURPOSE OF JOB:

We are currently seeking Clinical Analyst to support a growing client base while combining their clinical and/or coding expertise with payment accuracy. The Clinical Analyst is responsible for analyzing and interpreting and assign the correct codes for the descriptions available on various medical procedures and diagnosis and other related medical coding as per the medical policy requirements.

Principal Duties/ Responsibilities:

• Perform daily audits on client data for completeness and accuracy of coding utilizing both coding and clinical background to ensure appropriateness for reimbursement
• Respond to provider appeals.
• Respond to client logics and record reviews
• Monitor acceptance rates for assigned clients and assist management in proactively detecting negative deviations.
• Contribute to PCI product by providing feedback to Management/Development Teams on changes to enhance editing and efficiency.
• Reports his/her work performance on a timely basis to the team lead
• Works diligently to meet and exceed productivity and quality benchmarks
• Takes charge of ongoing learning and development and participates in relevant training and development activities

RELEVANT EXPERIENCE & EDUCATIONAL REQUIREMENTS:

• 1 years of experience in medical coding / US healthcare claims processing
• Experience with E&M and Denial Management
• Possesses knowledge of healthcare claims payment policy and processing –
• specifically, CMS, Medicaid regulations, AAOS, ICD-10, CPT & HCPCS, etc.
• Registered Nurse with CPC/COC certification or Bachelor's Degree from Allied Sciences with CPC certification
• Must be willing to work onsite

Office Location:

• Manila : Cotiviti Office located at 15th Floor, Robinsons Cyberscape Gamma, Topaz Rd, Ortigas Center, Pasig

Quality Analyst is responsible to perform activities outlined in the Service Quality Plan and identify auditor / program level improvement opportunities. QA Analyst is required to work closely with the production resources to ensure adherence to the client and process specific requirements. Ensure that regular feedback and error sharing sessions are conducted to avoid repetition of errors and help improve overall performance. Other activities of the quality analyst include – reporting, calibrations, process analysis and attending client and internal meetings.

Relevant Experience & Educational Requirements:

• Registered nurse with CIC / CCS coding certification
• Must have at least 1 year experience working as a QA
• Must have prior auditing experience; preferably DRG experience
• Possesses knowledge of healthcare claims payment policy and processing
• Must be willing to work onsite

Why Join Us?

• Competitive salary package
• Day 1 HMO coverage + 2 free dependents
• Annual appraisal and salary review
• Career growth opportunities
• Dynamic and supportive team culture
• Employee wellness and engagement initiatives

Quality Analyst is responsible to perform activities outlined in the Service Quality Plan and identify auditor / program level improvement opportunities. QA Analyst is required to work closely with the production resources to ensure adherence to the client and process specific requirements. Ensure that regular feedback and error sharing sessions are conducted to avoid repetition of errors and help improve overall performance. Other activities of the quality analyst include – reporting, calibrations, process analysis and attending client and internal meetings.

Responsibilities:

• Responsible for quality monitoring on claims/cases/transactions and/or telephonic interactions

• Conduct Process training as and when required

• Provide feedback to auditors/clinical team members using prescribed feedback model

• Mentoring and coaching auditors on process level issues.

• Monitor adherence to compliance procedures and processes.

• Responsible for reporting program level quality score to the process owners.

• Responsible for conducting calibration and performance review call in terms of quality with the internal team. (Initially will be assisting the senior quality analyst, training and guidance will be provided to be able to lead such meetings in future).

• Conduct refresher training on the basis of the errors identified.

• Communicate process updates by conducting a session as and when required.

• Maintaining update log and sharing it with the team on a regular basis.

• Perform brainstorming and root cause analysis to analyse data and provide tips or suggestions to operations/management team.

• Identify and highlight potential risk areas and recommend preventive action.

RELEVANT EXPERIENCE & EDUCATIONAL REQUIREMENTS:

• Registered Nurse with CPC/COC certification

• Minimum one year experience working as Team Leader or equivalent

• Experience in US Healthcare, medical coding, medical billing, RCM health plan

operations strongly preferred

• Possesses knowledge of healthcare claims payment policy and processing –

• specifically, CMS, Medicaid regulations, AAOS, ICD-9, CPT & HCPCS, etc.

• Practical clinical experience working in a hospital/office or nursing home

• Has general knowledge of medical procedures, conditions, illnesses, and treatment

practices

• Possesses excellent written and verbal communication skills. Ability to think logically

• and process sequentially with a high level of detailed accuracy and efficiency

• Has excellent personal computer skills in Microsoft Word, Excel, PowerPoint,

Outlook, etc.

• Experience working as a Quality Analyst will be an added advantage

• College degree mandatory

• Must be willing to work onsite

Office Locations:

• 15th Floor, Robinsons Cyberscape Gamma, Topaz Rd, Ortigas Center, Pasig, 1600

• 16th floor, 1 Nito Tower Archbishop Reyes Avenue Cebu City, 6000

We are currently seeking Philippine Registered Nurses (PHRN) who are looking to transition into a rewarding career in Medical Coding through our Medical Coding Academy program. If you have a passion for healthcare, strong clinical knowledge, and a desire to explore new career opportunities beyond bedside nursing, this program is designed for you.

Through our comprehensive training program, you will gain the skills and knowledge needed to build a successful career in Medical Coding while leveraging your nursing expertise in a dynamic healthcare environment.

Take the next step in your professional journey and join our Medical Coding Academy today!

• Graduate of Bachelors Degree in Nursing with Active PHRN License
• Minimum of 2 years of hospital bedside experience, with exposure to critical units (e.g. ICU, ER).
• Strong knowledge of medical terminology, human anatomy, and physiology.
• Willingness to learn and adapt to new healthcare technologies.
• Strong communication skills and attention to detail.
• Willingness to work onsite.

We Are Pooling Medical Coders (Q3 Start)!

We are currently pooling Medical Coders for our In/Outpatient Coding Programs, tentatively starting Q3. Newly coding-certified Registered Nurses without prior coding experience are welcome to apply.

Job Requirements:

• Must be a Registered Nurse
• Must have an active CPC or COC certification
• Must have knowledge of ICD , CPT, HCPCS, and E/M coding
• Must be willing to work onsite

What’s In It for You?

• Competitive salary package
• Day 1 HMO coverage, plus 2 dependents for free
• Annual performance appraisal, etc.
• Clear growth and career advancement opportunities
• Supportive work environment with continuous learning