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R1 RCM • Manila, Metro Manila, Philippines
Role & seniority: Inpatient Coding Quality Reviewer (mid-level QA role) for R1 RCM Philippines.
Stack/tools: Medical coding software (Epic, Cerner, Meditech, 3M 360); CMS guidelines; ICD-10-CM/PCS; AHIMA standards; AHA Coding Clinic.
Conduct audits of inpatient medical coding across multiple specialties for accuracy and compliance.
Provide clear rationale and references for audit findings; identify coding error trends and support root-cause analysis.
Stay updated on coding guidelines, payer requirements, client policies; prepare and present audit reports and trends.
≥2 years in medical coding or billing review.
Certification: CCS, CIC, RHIA, RHIT (or alternative CPT/CCS-P/COC/CPMA as applicable).
Bachelor’s in medical-allied field (or other degree with proven coding expertise); strong knowledge of CMS guidelines, MS-DRG/APR-DRG, IPPS.
Proficiency with coding software (Epic, Cerner, Meditech, 3M 360).
Nice-to-haves: Experience in outpatient coding and auditing.
Location & work type: Quezon City and Cebu, Philippines; on-site/full-time role with growing QA team.
R1 RCM PHILIPPINES, INC. is a leading provider of technology-driven, end-to-end revenue cycle solutions that transform the patient experience and financial performance of healthcare providers. R1 RCM Philippines serves as a strategic hub for global operations providing critical support in areas such as medical coding, patient services, scheduling, denials management, and operational excellence. Combining global expertise with local talent, we improve patient journeys while building sustainable careers and advancing the future of healthcare delivery worldwide.
We are growing our Quality Assurance team in Quezon City and Cebu! As an Inpatient Coding Quality Reviewer, you will perform internal audits of inpatient medical coding to ensure accuracy, compliance, and adherence to official guidelines. This role focuses on identifying coding errors, improving efficiency, and providing educational feedback to coders. You will work closely with operations and training teams to uphold high standards of coding quality and compliance with payer and regulatory requirements.
Responsibilities Conduct audits of inpatient medical coding across multiple specialties to ensure accuracy and compliance with official guidelines. Provide clear rationale and supporting references for all audit findings and recommendations. Use industry-standard references such as ICD-10-CM/PCS guidelines, AHIMA standards, and AHA Coding Clinic. Identify coding error trends and contribute to root cause analysis. Stay updated on coding guidelines, payer requirements, and client-specific policies. Prepare and present reports summarizing audit results and trends.
Qualifications At least 2 years in a medical coding or billing review role
Holds at least one relevant certification: CCS, CIC, RHIA, or RHIT (Other relevant Certification: CPC, COC, CPMA, or CCS-P) Bachelor’s degree in a medical-allied course. (Other non-medical degrees are accepted with proven expertise and relevant experience in medical coding.) Strong knowledge of CMS guidelines, MS-DRG/APR-DRG and Inpatient Prospective Payment System (IPPS). Proficiency with coding software such as Epic, Cerner, Meditech, and 3M 360 Experience in outpatient coding and auditing preferred.
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NOTICE: Please be informed that NO candidate seeking a job opportunity with R1 Philippines shall be required to pay any amount as a condition for employment at R1. R1 does not authorize any third party, agency, company or individual to collect money or request any monetary arrangement in order to receive a job at R1. If you are contacted by someone asking for payment, please do not respond, and contact us at PH HR - Talent Acquisition phhrtalentacquisition@r1rcm.com or report to our Ethics Point Hotline, by phone or online access https://r1hotline.ethicspoint.com Philippines: 18.001.322.0411 or contact Compliancephl@r1rcm.com immediately. Show more Show less