Medical Coder - RN

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

• Provide additions, deletions or updates to diagnosis codes, procedure codes, age minimums & maximums, quantity limitations, place of service limitations and other clinical content criteria
• 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
• Responsible for making recommendations within the software for the denial of diagnosis, age, or other criteria on medical claims based on coding guidelines

Required Skills & Experience

• BS Nursing or equivalent required
• 4 years' experience in medical billing, coding, claims processing, bill and/or chart review/auditing, is 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
• Excellent communication skills (verbal and written) enabling effective communication both internally with all areas of the business and externally
• Demonstrated proficiency with various software applications, including but not limited to: MS Word; MS Excel; MS Access; Visio; JIRA; SharePoint with MS project a plus
• AHIMA Certified Coding Specialist - Physician (CCS-P) or AAPC Certified Professional Coder (CPC) is required