Medial Coding Senior Specialist
Taguig
Review diagnosis and medication coding for infusion services, particularly in complex or restricted payer scenarios
- Evaluate payer medical policies and regulatory guidelines to determine coverage and medical necessity
- Ensure alignment between clinical documentation and billing codes prior to service delivery
- Coordinate and validate completion of beneficiary notices and required modifiers within the system
- Apply advanced knowledge of Medicare guidelines and FDA label coverage to resolve coding exceptions
- Collaborate with intake, billing, and clinical teams to address discrepancies and improve documentation practices
- Identify and resolve complex reimbursement and compliance issues, escalating where necessary
- Maintain clear, audit-ready documentation to support coding decisions and post-payment reviews
- Support adherence to regulatory, payer, and organisational billing standards
- Participate in process improvement initiatives to enhance coding accuracy and reimbursement outcomes
- Train and mentor junior team members on coding practices, systems, and workflows
- Bachelor's degree in Nursing, Health Information Management, Medical Coding, or a related field
- Active Certified Professional Coder (CPC) certification or equivalent; or active nursing licence
- At least 3 years of experience in medical coding, healthcare billing, or revenue cycle management
- Strong understanding of coding systems, payer policies, and healthcare workflows
- Experience interpreting Medicare guidelines and infusion-related coding practices
- Ability to analyse complex coding scenarios and resolve reimbursement challenges independently
- Strong collaboration and communication skills for cross-functional engagement
- Experience in hospital outpatient or infusion coding environments is preferred
- Additional certifications in outpatient or oncology coding are advantageous
- Exposure to multilingual environments is a plus
- Opportunity to work on specialised and complex healthcare coding cases
- Exposure to a structured, compliance-driven global organisation
- Continuous learning and professional development in advanced coding practices
- Collaborative work environment with cross-functional team engagement
Epsilon Group ServicesManila, 12 km from Taguig
experience (Non-negotiable)
• Strong knowledge of ICD-10-CM, ICD-10-PCS, DRG, and inpatient coding guidelines
• Excellent attention to detail and analytical skills
• Willing to work onsite in Cubao, Quezon City
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