IP Quality Assurance Specialist

R1 RCM PHILIPPINES, INC. is a leading provider of technology-driven, end-to-end revenue cycle solutions that transform the patient experience and financial performance of healthcare providers. R1 RCM Philippines serves as a strategic hub for global operations providing critical support in areas such as medical coding, patient services, scheduling, denials management, and operational excellence. Combining global expertise with local talent, we improve patient journeys while building sustainable careers and advancing the future of healthcare delivery worldwide.

We are growing our Quality Assurance team in Quezon City and Cebu!

As an Inpatient Coding Quality Reviewer, you will perform internal audits of inpatient medical coding to ensure accuracy, compliance, and adherence to official guidelines. This role focuses on identifying coding errors, improving efficiency, and providing educational feedback to coders. You will work closely with operations and training teams to uphold high standards of coding quality and compliance with payer and regulatory requirements.

Responsibilities

• Conduct audits of inpatient medical coding across multiple specialties to ensure accuracy and compliance with official guidelines.
• Provide clear rationale and supporting references for all audit findings and recommendations.
• Use industry-standard references such as ICD-10-CM/PCS guidelines, AHIMA standards, and AHA Coding Clinic.
• Identify coding error trends and contribute to root cause analysis.
• Stay updated on coding guidelines, payer requirements, and client-specific policies.
• Prepare and present reports summarizing audit results and trends.

Qualifications

• At least 5 years in Inpatient Medical Coding
• With at least 1 Year of IP QA Experience
• Holds at least one relevant certification: CCS, CIC, RHIA, or RHIT (Other relevant Certification: CPC, COC, CPMA, or CCS-P)
• Bachelor's degree in a medical-allied course. (Other non-medical degrees are accepted with proven expertise and relevant experience in medical coding.)
• Strong knowledge of CMS guidelines, MS-DRG/APR-DRG and Inpatient Prospective Payment System (IPPS).
• Proficiency with coding software such as Epic, Cerner, Meditech, and 3M 360
• Experience in outpatient coding and auditing preferred.
• Amenable for hybrid work set-up.

Our team experience these benefits of joining our mission:

• Career development programs designed for your goals
• Certificate renewal assistance
• Clinical Allowances and Incentives
• Annual performance-based merit increase
• HMO coverage starting Day 1
• Attractive sign-on bonus* and more! (*Terms & Conditions may apply)

#R1Philippines #AlltogetherBetter #R1JoinTheJourney

Grow with us!

NOTICE: Please be informed that NO candidate seeking a job opportunity with R1 Philippines shall be required to pay any amount as a condition for employment at R1.

R1 does not authorize any third party, agency, company or individual to collect money or request any monetary arrangement in order to receive a job at R1.

If you are contacted by someone asking for payment, please do not respond, and contact us at PH HR - Talent Acquisition [Confidential Information] or report to our Ethics Point Hotline, by phone or online access https://r1hotline.ethicspoint.com Philippines: 18.001.322.0411 or contact [HIDDEN TEXT] immediately.