Appeals Coder

OPAS Appeals Coder / Cardiovascular Nurse

Location: Quezon City, Makati, or Muntinlupa

Work Setup: Hybrid

Schedule: Shifting Schedule

Job Summary

The OPAS Appeals Coder / Cardiovascular Nurse is responsible for reviewing and extracting pertinent clinical information from patient medical records and preparing well-supported appeal letters based on established guidelines and process requirements. This role requires strong clinical and coding expertise to ensure accurate, high-quality case reviews while meeting productivity and turnaround time expectations.

Key Responsibilities

• Review patient medical records and identify relevant clinical information for appeals processing.
• Accurately extract and document case details based on established guidelines.
• Prepare clear, concise, and defensible appeal letters supported by clinical documentation and coding standards.
• Ensure all cases are completed within established productivity and quality targets.
• Maintain compliance with company policies, client requirements, and regulatory standards.
• Collaborate with internal teams to resolve case-related concerns and ensure accurate outcomes.
• Apply clinical knowledge and coding expertise to support appeal decisions and documentation reviews.
  
  
  

• Bachelor's Degree in Nursing.
• Active Philippine Registered Nurse (PHRN) License.
• Active Coding Certification such as:
• CCS
• CCS-P
• CPC-H
• CPC
• RHIT
• RHIA
• CDIP
• CCDS
  
• At least 3 years of recent clinical bedside experience within the last 5 years in a tertiary or secondary hospital setting, preferably in:
• ICU
• CCU
• Telemetry
• Cardiovascular ICU
• Medical ICU
• Emergency Room (ER)
• Medical-Surgical Unit (MS)
  
• Minimum of 2 years of medical coding experience.
• Strong attention to detail, analytical skills, and clinical judgment.
• Excellent written and verbal communication skills.