Medical Coder

MicroSourcing; Taguig; Remote; PHP 100,000 - 400,000; Full time

Job summary

A healthcare solutions provider is seeking a Medical Content Analyst to conduct research on medical coding and billing for automated claims solutions in the US. The ideal candidate must have a Bachelor's in Nursing, an active RN license, and be certified in medical coding. The role requires strong communication skills and is amenable to night shifts and remote work arrangements.

Qualifications

• Minimum 5 years of experience in CPT Coding, HCPCS, and Medical Billing.
• Previous experience with US health insurance payers in claims, appeals, or coding.
• Experience in denial management or claim review management is an advantage.

Responsibilities

• Research and identify claims criteria for automated claims editing.
• Provide presentations to Medical Director and clinical colleagues.
• Perform data entry of clinical content updates as needed.
• Solve problems related to inpatient coding or ICD-10-CM.

Skills

CPT Coding

HCPCS

Medical Billing

Claims Denials

Chart Review/Auditing

Excellent Communication Skills

Proficient in MS Office Applications

Education

Bachelor's Degree in Nursing

Active RN (PRC) License

AHIMA Certified Coding Specialist - Physician (CCS-P)

AAPC Certified Professional Coder (CPC)

Job description

Overview

Position: Medical Content Analyst
Location: GSC Tower, BGC, Taguig City
Work Set-up & Shift: Work From Home and Night Shift

Position Summary:
The Medical Content Analyst will be responsible in conducting research and identifying Medicare, Medicaid, and other medical coding and billing documents to identify claim denial or covered criteria (clinical content) for our automated claims editing solution.

This solution is utilized by medical insurance payers across the United States. The clinical content could include additions, deletions or updates to diagnosis codes, procedure codes, minimums & maximums, quantity limitations, place of service limitations and other clinical content criteria.

Duties and Responsibilities:

• Research and identify Medicare, Medicaid, and other medical coding and billing documents to identify claim denial or covered criteria (clinical content) for our automated claims editing solution.

• Provide written and oral presentations to Medical Director (physicians) and other clinical colleagues to obtain consensus on proposed denial criteria.

• Provide clinical content support to our customers as needed

• Perform data entry of clinical content updates into database, as needed

• Solve problems related to the interpretation of inpatient coding or ICD-10-CM coding conventions/guidelines for inclusion or exclusion within Lyric business rules.

Required Qualifications:

• Bachelor\'s Degree in Nursing.

• Must have an Active RN (PRC) License.

• Must be an AHIMA Certified Coding Specialist - Physician (CCS-P) or AAPC Certified Professional Coder (CPC).

• At least 5 years of experience in the areas of CPT Coding, HCPCS, Medical Billing, Claims Denials and/or Chart Review/Auditing are required.

• Previous experience working with US health insurance payers in a claims, appeals or coding capacity is also required.

• Experience in denial management or claim review management is a plus/advantage.

• Excellent Communication Skills (verbal and written) enabling effective communication with all areas of the business.

• Proficient in using MS Office Applications.

• Amenable to Work on Night Shift.

• Amenable to Work From Home Set-Up.