URGENTLY seeking a meticulous and experienced "QA Surgery Coder" to become the guardian of coding accuracy within a dynamic healthcare BPO team. Your expertise will be pivotal in auditing complex surgical charts, safeguarding compliance, and elevating the performance of the coding specialists in a fast-paced environment.

The Core Mission: Rigorously audit surgical medical codes (CPT, ICD-10, HCPCS) to ensure absolute accuracy and adherence to all regulatory and client-specific requirements. Your vigilance directly impacts claim acceptance and revenue integrity.

Collaboration for Excellence: Partner closely with coding teams, transforming audit findings into actionable insights. Your feedback and guidance are crucial to improve overall coding quality, significantly reduce claim denials, and consistently meet or exceed client Service Level Agreements (SLAs).

Key Responsibilities: Conduct Comprehensive Audits. Meticulously review surgical charts for coding accuracy, appropriate modifier application, and strict documentation compliance.

Identify & Analyze Trends: Proactively spot error patterns and coding discrepancies. Provide clear, constructive, and actionable feedback to coders to drive continuous improvement.

Develop Quality Frameworks: Create and refine QA audit guidelines, tools, and targeted training materials specifically focused on surgery coding nuances.

Support Revenue Cycle: Leverage your coding expertise to strengthen denial management and appeal processes, providing the critical coding insights needed to overturn unjustified denials.

Uphold Performance Standards: Maintain a personal audit accuracy rate of 95% or higher while strictly adhering to defined turnaround times for audit completion.

Stay Ahead of the Curve: Continuously update your knowledge on the latest coding guidelines issued by CMS, AMA, and specific client mandates.

1. Education: Bachelor’s Degree in Healthcare Administration, Nursing, Medical Technology, or a closely related field.
2. Surgery Coding Expertise: Minimum of 2–3 years of hands-on, practical experience coding complex surgical procedures. Must include demonstrated experience in specialties such as Orthopedics, Cardiology, General Surgery, etc.
3. Active PHRN License: Possess an active and unrestricted Philippine Registered Nurse (PHRN) license. Please note that you must be prepared to submit your valid PRC ID number.
4. BPO Experience: Minimum of 2 years of proven experience working within a healthcare Business Process Outsourcing (BPO) environment. This requirement has no exceptions.

Application Instructions:

Your Resume MUST Clearly Include:

• Your active PHRN license number.

• Detailed breakdown of your surgery coding experience. Specify specialties worked in (e.g., ortho, cardio, neuro, general) and approximate case volume/throughput.

• Complete BPO employment history: Include company names, dates of employment, and client names ("if" confidentiality agreements permit disclosure).