Claims Expert

Taguig, Metro Manila, Philippines • Posted June 19, 2026

Job Type: Full-time

Location: Taguig, Metro Manila

Posted: June 19, 2026

Category: other-general

Application Deadline: July 29, 2026

Role Description

Responsibilities:
- Review and validate diagnosis and medication coding for infusion services, with a focus on payer-specific requirements and restrictions, serving as the primary resource for complex or non-standard cases.
- Analyze payer medical policies and CMS guidelines to determine coverage eligibility and medical necessity, providing expert interpretation in ambiguous or evolving policy situations.
- Ensure clinical documentation is accurately aligned with billing and coding requirements before services are rendered.
- Oversee the completion and validation of Advance Beneficiary Notices (ABNs), ensuring appropriate modifier usage and system documentation.
- Apply advanced knowledge of Medicare regulations and FDA-approved indications to support coding decisions, independently addressing exceptions, denials, and off-label coverage scenarios.
- Partner with infusion intake, billing, and clinical teams to resolve coding inconsistenc...
                

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