Medical Coder — Denials & Clinical Content Expert

Prime Manpower Resources Development Inc; Taguig; On-site; PHP 360,000 - 540,000; Full time

Job summary

Prime Manpower Resources Development Inc. seeks a Medical Coding Specialist with strong knowledge of ICD-10-CM guidelines and denial management. You will update codes and clinical content, and provide clear guidance to physicians and colleagues to align with payer rules.

The role requires 4 years of medical billing/coding experience, a BS Nursing or equivalent, and CCS-P or CPC certification. Proficiency with MS Office, Visio, JIRA, SharePoint, and MS Project is advantageous.

Qualifications

• BS Nursing or equivalent is required.
• 4 years' experience in medical billing, coding, claims processing, or chart auditing.
• Experience with US health insurance payers in claims, appeals, or coding.
• AHIMA CCS-P or CPC certification is required.

Responsibilities

• Provide additions, deletions or updates to diagnosis/procedure codes and clinical content criteria.
• Present written and oral recommendations to Medical Director to reach consensus on denial criteria.
• Support customers with clinical content needs.
• Enter clinical content updates into the database.
• Interpret inpatient coding and ICD-10-CM guidelines for Lyric business rules and denials.

Skills

Communication skills

Attention to detail

Problem-solving

Education

BS Nursing or equivalent

AHIMA CCS-P or CPC

Tools

MS Word

MS Excel

MS Access

Visio

JIRA

SharePoint

MS Project

Job description

Prime Manpower Resources Development Inc. seeks a Medical Coding Specialist with strong knowledge of ICD-10-CM guidelines and denial management. You will update codes and clinical content, and provide clear guidance to physicians and colleagues to align with payer rules.

The role requires 4 years of medical billing/coding experience, a BS Nursing or equivalent, and CCS-P or CPC certification. Proficiency with MS Office, Visio, JIRA, SharePoint, and MS Project is advantageous.