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Claims Expert

Cobden & Carter International · Taguig, Metro Manila, Philippines

Location
Taguig
Job Type
Full-time
Posted
July 17, 2026

Job 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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