Found Description
- Gain exposure to complex payer policies and Medicare guidelines
- Collaborate cross-functionally with clinical and billing professionals
About Our Client
The client is a globally leading healthcare firm based in the US with a shared service operation in the Philippines.
Job Description
- Review and validate diagnosis and medication coding for infusion services, especially under payer restrictions
- Evaluate payer medical policies and CMS guidelines to assess medical necessity and coverage eligibility
- Ensure alignment between clinical documentation and billing codes before services are rendered
- Coordinate and ensure proper completion of Advance Beneficiary Notices (ABNs), including correct modifier usage
- Apply Medicare guidelines and FDA label coverage criteria in coding decisions
- Collaborate cross-functionally with infusion intake, clinical, and billing teams to resolve d...