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.
Qualifications- 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.
