Clinical Content Analyst - Claims & Coding Expert

Lyric; Manila; On-site; PHP 350,000 - 550,000; Full time

Job summary

Lyric, a leader in healthcare decision intelligence, seeks a qualified professional to manage clinical content for claims and coding. You will update diagnosis and coding criteria, present denial criteria to physicians, and support customers with authoritative content.

The role requires a nursing background (BS) and 4+ years in medical billing/coding, with US payer experience and CCS-P or CPC certification. Strong communication and software skills are essential.

Qualifications

• BS Nursing or equivalent is required.
• 4 years’ experience in medical billing, coding, claims processing, or chart review/auditing.
• Experience with US health insurance payers in claims, appeals or coding capacity.
• Experience in denial management or claim review is a plus.
• Excellent verbal and written communication skills.
• Proficiency with MS Office, Visio, JIRA, SharePoint; MS Project a plus.
• AHIMA CCS-P or AAPC CPC certification is required.

Responsibilities

• Update diagnosis codes, procedure codes, age limits, quantity limits and other clinical criteria.
• Present to Medical Director and clinicians to gain consensus on denial criteria.
• Provide clinical content support to customers as needed.
• Enter clinical content updates into the database.
• Address issues in inpatient coding and ICD-10-CM conventions for Lyric rules.
• Recommend software-based denial decisions based on coding guidelines.

Skills

Medical billing

Medical coding

US payer experience

Denial management

Communication

Software literacy

Education

BS Nursing

AHIMA CCS-P

AAPC CPC

Tools

MS Word

MS Excel

MS Access

Visio

JIRA

SharePoint

MS Project

Job description

Lyric, a leader in healthcare decision intelligence, seeks a qualified professional to manage clinical content for claims and coding. You will update diagnosis and coding criteria, present denial criteria to physicians, and support customers with authoritative content.

The role requires a nursing background (BS) and 4+ years in medical billing/coding, with US payer experience and CCS-P or CPC certification. Strong communication and software skills are essential.