Medical Content Analyst

MicroSourcing; Cagayan de Oro; On-site; PHP 480,000 - 720,000; Full time

Job summary

MicroSourcing is seeking a Medical Content Analyst 3 to research Medicare/Medicaid coding and identify claim denial or coverage criteria for automated claims editing. You will analyze clinical content, propose denial criteria, and support customers with updated content in the database.

The role requires 4+ years in medical billing/coding, US payer experience, and CCS-P or CPC certification. Remote options are available while based in the Philippines.

Qualifications

• BS Nursing, BS Pharmacy or equivalent required.
• At least 4 years’ experience in medical billing, coding, claims processing, bill and/or chart review/auditing.
• Experience working with US health insurance payers in a claims, appeals or coding capacity 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 and MS Project a plus.
• AHIMA CCS-P or AAPC CPC required.

Responsibilities

• Research and identify Medicare, Medicaid, and other medical coding and billing documents to identify claim denial or covered criteria for our automated claims editing solution.
• Provide written and oral presentations to the Medical Director 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 the 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.

Skills

Excellent communication skills

US health payer experience

Medical coding knowledge

Education

BS Nursing or BS Pharmacy

Tools

MS Word

MS Excel

MS Access

Visio

JIRA

SharePoint

MS Project

Job description

Job Title

Medical Content Analyst 3

Job Type & Location

Full‑time. Remote. Cagayan De Oro City, Misamis Oriental, Philippines.

Job Summary

The Medical Content Analyst 3 will research and identify Medicare, Medicaid, and other medical coding and billing documents to identify claim denial or covered criteria for our automated claims editing solution. The clinical content may include additions, deletions or updates to diagnosis codes, procedure codes, age minimums and maximums, quantity limitations, place of service limitations and other clinical content criteria. The Analyst will present written and oral proposals to the Medical Director and other clinical colleagues to obtain consensus on proposed denial criteria, provide clinical content support to customers, and perform data entry of clinical content updates into the database.

Responsibilities

• Research and identify Medicare, Medicaid, and other medical coding and billing documents to identify claim denial or covered criteria for our automated claims editing solution.
• Provide written and oral presentations to the Medical Director 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 the 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.

Qualifications

• BS Nursing, BS Pharmacy or equivalent required.
• At least 4 years’ experience in medical billing, coding, claims processing, bill and/or chart review/auditing.
• Experience working with US health insurance payers in a claims, appeals or coding capacity 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 and MS Project a plus.
• AHIMA Certified Coding Specialist – Physician (CCS‑P) or AAPC Certified Professional Coder (CPC) required.

Benefits

• Competitive rewards with above‑market compensation and healthcare coverage from day one, plus dependents.
• Paid time‑off with cash conversion.
• Group life insurance and performance bonuses.
• Flexibility with work‑life harmony.
• Continuous learning and career advancement opportunities.
• Inclusive, diverse, and supportive team culture.