RCM Senior Specialist

Job Title: Medical Coder

Skills: 2–4 years in Medical Coding (physician groups, hospital billing, or healthcare BPO)

Experience: Exposure to Chart Reviews, Clinical Documentation, DRG audit, E&M coding, InterQual

Location: Muntinlupa, Philippines

We at Coforge are hiring Medical Coder with the following skillset:

• Chart Reviews
• Clinical Documentation Improvement
• DRG checking/audit
• E&M coding reviews
• Clinical Education
• 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.