Impactful Clinical Coding & Claims Analytics Consultant

Milliman Ireland; Hinoba-an; On-site; PHP 600,000 - 800,000; Full time

Job summary

Milliman Ireland is seeking a Clinical Coding & Claims Analytics Consultant with experience in clinical coding, medical claims analysis, reimbursement methodologies, and healthcare consulting.

The role will support the development of clinical rules for claims adjudication, perform coding and reimbursement analytics, contribute to DRG and grouper initiatives, and deliver consulting projects for healthcare payers, providers, and health system stakeholders.

Qualifications

• Bachelor's degree in a healthcare field and HIMAA certification or equivalent.
• 2–4 years experience in clinical coding, claims analytics, or reimbursement analysis.
• Strong understanding of coding standards and medical claims lifecycle.

Responsibilities

• Develop clinical rules for medical claims adjudication and payment integrity.
• Perform coding reviews, mapping across ICD-10-AM, ACHI, SBS and AR-DRG systems.
• Analyze claims data to identify discrepancies and reimbursement opportunities.
• Contribute to DRG grouper validation and fee schedule development.
• Prepare analytical reports and client deliverables across multiple workstreams.

Skills

Analytical thinking

Problem solving

Documentation

Excel proficiency

Education

Bachelor's degree in Medicine or related healthcare discipline

HIMAA certification

Tools

ICD-10-AM, ACHI, SBS, AR-DRG knowledge

Job description

Milliman Ireland is seeking a Clinical Coding & Claims Analytics Consultant with experience in clinical coding, medical claims analysis, reimbursement methodologies, and healthcare consulting.

The role will support the development of clinical rules for claims adjudication, perform coding and reimbursement analytics, contribute to DRG and grouper initiatives, and deliver consulting projects for healthcare payers, providers, and health system stakeholders.