Medical Coder - RN

prime manpower resources development, inc.; Taguig; On-site; PHP 550,000 - 750,000; Full time

Job summary

prime manpower resources development, inc. is seeking a qualified medical coding professional to manage updates to diagnosis and procedure codes, age/quantity limitations, and other clinical criteria. You will present findings to the Medical Director to secure consensus on denial criteria and support customers with clinical content.

Strong data-entry skills and knowledge of coding guidelines are essential. Requirements include a BS Nursing or equivalent and 4 years in medical billing/coding,

Qualifications

• BS Nursing or equivalent required.
• 4 years experience in medical billing, coding, claims processing, bill and/or chart review/auditing.
• Experience with US health insurance payers in a claims, appeals or coding capacity is required.
• Experience in denial management or claim review management is a plus.
• Excellent communication skills (verbal and written).
• Proficiency with MS Word, MS Excel, MS Access, Visio, JIRA, SharePoint; MS Project a plus.

Responsibilities

• Provide additions, deletions or updates to diagnosis codes, procedure codes, age min/max, quantity limitations and other clinical content criteria.
• Present written and oral findings to Medical Director and colleagues to obtain consensus on proposed denial criteria.
• Provide clinical content support to customers as needed.
• Perform data entry of clinical content updates into database as needed.
• Resolve issues related to interpretation of inpatient coding or ICD-10-CM conventions for inclusion or exclusion within Lyric business rules.
• Recommend software-denial criteria on medical claims based on coding guidelines.

Skills

Communication skills

MS Office

JIRA

SharePoint

Education

BS Nursing or equivalent

Tools

MS Word

MS Excel

MS Access

Visio

Job description

Essential Job Responsibilities:

• 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