Appeals Coder

OPAS Appeals Coder / Cardiovascular Nurse

Location: Quezon City Makati or Muntinlupa
Work Setup: Hybrid
Schedule: Shifting Schedule

The OPAS Appeals Coder / Cardiovascular Nurse is responsible for reviewing and extracting pertinent clinical information from patient medical records and preparing well-supported appeal letters based on established guidelines and process requirements. This role requires strong clinical and coding expertise to ensure accurate high-quality case reviews while meeting productivity and turnaround time expectations.

• Review patient medical records and identify relevant clinical information for appeals processing.
• Accurately extract and document case details based on established guidelines.
• Prepare clear concise and defensible appeal letters supported by clinical documentation and coding standards.
• Ensure all cases are completed within established productivity and quality targets.
• Maintain compliance with company policies client requirements and regulatory standards.
• Collaborate with internal teams to resolve case-related concerns and ensure accurate outcomes.
• Apply clinical knowledge and coding expertise to support appeal decisions and documentation reviews.

• Bachelors Degree in Nursing.
• Active Philippine Registered Nurse (PHRN) License.
• Active Coding Certification such as:
  • CCS
  • CCS-P
  • CPC-H
  • CPC
  • RHIT
  • RHIA
  • CDIP
  • CCDS
• At least 3 years of recent clinical bedside experience within the last 5 years in a tertiary or secondary hospital setting preferably in:
  • ICU
  • CCU
  • Telemetry
  • Cardiovascular ICU
  • Medical ICU
  • Emergency Room (ER)
  • Medical-Surgical Unit (MS)
• Minimum of 2 years of medical coding experience.
• Strong attention to detail analytical skills and clinical judgment.
• Excellent written and verbal communication skills.