Carelon Global Solutions Philippines

USRN Medical Coder - 2026 Find Human Resources

Carelon Global Solutions Philippines  •  Republic of the Philippines (Onsite)  •  5 months ago
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Job Description

Position Title:

USRN Medical Coder - 2026 Find Human Resources

Shift:

"Responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims.
• Primary duties may include but are not limited to:
• Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities.
• Draws on advanced ICD-10 coding expertise, mastery of clinical guidelines, and industry knowledge to substantiate conclusions.
• Utilizes audit tools, auditing workflow systems and reference information to generate audit determinations and formulate detailed audit findings letters.
• Maintains accuracy and quality standards as established by audit management.
• Identifies potential documentation and coding errors by recognizing aberrant coding and documentation patterns such as inappropriate billing for readmissions, inpatient admission status, and Hospital-Acquired Conditions (HACs).
• Suggests and develops high quality, high value, concept and or process improvement and efficiency recommendations.
• Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing guidelines, payer reimbursement policies, and coding terminology preferred.

Required Qualifications:
US RN - with at least two years of hospital experience
Several years of inpatient hospital coding experience
One or more of the following certification:
• Certified Clinical Documentation Specialist (CCDS)
• Certified Documentation Improvement Practitioner (CDIP)
• Certified Professional Coder (CPC)
• Inpatient Coding Credential such as CCS or CIC
No specific state licensure

Preferred Qualifications (at least 1- Bed side nursing)
• ICU, CCU, Emergency Room, Trauma Care
• -RHIT or RHIA (preferred Certification)"

Carelon Global Solutions Philippines

About Carelon Global Solutions Philippines

Carelon Global Solutions makes healthcare operations more practical, effective, and efficient. Our global team of more than 25K innovators drives growth, delivers exceptional support, and develops digital tools specifically for health plans, providers, and systems. Each day, our partners and experts from across the globe implement new ways to save time and money — so doctors can focus on care.

Formerly known as Legato Health Technologies, Carelon Global Solutions is part of the Carelon family of brands and is a fully owned subsidiary of Elevance Health. Headquartered in the United States, Carelon Global Solutions has talented teams in India, Ireland, the Philippines, and Puerto Rico.

Want to be part of something meaningful? Join our growing team.

We believe that when bold talent meets limitless thinking, the possibilities are endless. As part of our Philippines team, you’ll work alongside some of the best minds in the business to solve healthcare’s most complex challenges. You’ll be part of an exciting, fast-paced, and supportive company culture, where all associates receive:

• Competitive pay.

• Generous benefits.

• Training, mentorship, and growth.

• Hybrid workplace flexibility.

• The opportunity to help others and make a difference.

Follow our Carelon Global Solutions Philippines LinkedIn page for the latest job postings and timely company news.

Industry
IT & Software
Company Size
1,001-5,000 employees
Headquarters
Bonifacio Global City, PH
Year Founded
Unknown
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