Job Title: RCM Blended (Senior Specialist)
Skills: 2–4 years in RCM (physician groups, hospital billing, or healthcare BPO)
Experience: Exposure to Chart Reviews, Clinical Documentation, DRG checking/audit, E&M coding, Multispecialty Medical Coding, LCD/NCD
Location: Muntinlupa, Philippines
We at Coforge are hiring RCM Blended (Senior Specialist) with the following skillset:
- Chart Reviews
- Clinical Documentation Improvement
- DRG checking/audit
- E&M coding reviews
- provider education for CDI
- Multispecialty Medical Coding
- Payer policies
- CMS guidelines
- LCD/NCD
- Medical Necessity
- Preferred certifications: CDIP, CCDS, CPHQ, CMAS, CPC.
Responsibilities:
- Conduct concurrent and retrospective chart reviews for documentation accuracy and completeness.
- Identify gaps and issue compliant provider queries.
- Ensure documentation supports correct DRG/APC assignment and risk adjustment.
- Provide feedback to improve provider documentation quality.
- Perform initial, concurrent, and retrospective reviews for appropriate level of care.
- Apply InterQual/MCG criteria to validate medical necessity.
- Document UM decisions in line with regulatory and payer requirements.
- Escalate cases to Physician Advisors when needed and support denial prevention efforts.
- Collaborate with coding and billing teams to resolve documentation/medical necessity issues.
- Support audits and root-cause analysis for denials.
