Medical Content Analyst

Magnum Transaction Sub Philippines, LLC.; Manila; On-site; PHP 500,000 - 800,000; Full time

Job summary

Magnum Transaction Sub Philippines, LLC. is looking for a medical coding specialist. This role involves updating diagnosis and procedure codes, collaborating with medical professionals, and providing clinical content support. Candidates should have a BS in Nursing or equivalent, along with coding certifications such as CCS-P or CPC.

Experience with U.S. health insurance payers, strong communication skills, and proficiency in software applications like MS Office are essential for success in this position.

Qualifications

• Minimum 4 years of experience in medical billing, coding, claims processing, bill and/or chart review/auditing.
• Previous experience working with U.S. health insurance payers in a claims, appeals, or coding capacity.
• Experience in denial management or claim review management is a plus.

Responsibilities

• Provide additions, deletions, or updates to diagnosis codes and procedure codes.
• Make recommendations for denial of diagnosis based on coding guidelines.
• Provide clinical content support to customers as needed.

Skills

Medical billing expertise

ICD-10-CM coding knowledge

Excellent communication skills

Proficiency in MS Office applications

Education

BS in Nursing or equivalent

AHIMA Certified Coding Specialist (CCS-P)

AAPC Certified Professional Coder (CPC)

Tools

MS Word

MS Excel

MS Access

Visio

JIRA

SharePoint

MS Project

Job description

Essential Job Responsibilities & Key Performance Outcomes

• 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 the 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 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.
• Make recommendations within the software for the denial of diagnosis, age, or other criteria on medical claims based on coding guidelines.

Required Skills & Experience

• BS in Nursing or equivalent required.
• Minimum 4 years of experience in medical billing, coding, claims processing, bill and/or chart review/auditing.
• Previous experience working with U.S. health insurance payers in a claims, appeals, or coding capacity.
• Experience in denial management or claim review management is a plus.
• Excellent communication skills (verbal and written) enabling effective communication internally with all areas of the business and externally.
• Demonstrated proficiency with various software applications, including MS Word, MS Excel, MS Access, Visio, JIRA, SharePoint, and MS Project.
• AHIMA Certified Coding Specialist – Physician (CCS-P) or AAPC Certified Professional Coder (CPC) required.