Medical Content Analyst

Color Employer, LLC; Manila; Hybrid; PHP 446,400 - 669,600; Full time

Job summary

Color Employer, LLC is looking for a Medical Content Analyst in Manila, Philippines. This role involves researching Medicare and Medicaid documents to determine claim denial criteria. Analysts will provide presentations and clinical support and perform data entry for updates.

The ideal candidate should possess a BS in Nursing, at least 4 years of experience in medical billing, and hold coding certifications (CCS-P or CPC). Communication skills and proficiency in various software are essential.

Qualifications

• BS Nursing or equivalent required.
• Minimum of 4 years' experience in medical billing, coding, claims processing, or auditing.
• Previous experience with U.S. health insurance payers is required.
• Experience in denial management is a plus.
• Excellent communication skills for internal and external communication.
• Proficiency with software applications is necessary.

Responsibilities

• Provide written and oral presentations to reach consensus on proposed denial criteria.
• Offer clinical content support to customers as needed.
• Perform data entry of clinical content updates.
• Solve issues related to inpatient coding or ICD-10-CM guidelines.
• Make recommendations for denial of medical claims based on guidelines.

Skills

Strong verbal and written communication skills

Proficiency with MS Word

Proficiency with MS Excel

Proficiency with MS Access

Experience with JIRA

Experience with SharePoint

Experience with MS Project

Education

Bachelor of Science in Nursing or equivalent

AHIMA Certified Coding Specialist – Physician (CCS-P) or AAPC Certified Professional Coder (CPC)

Tools

MS Word

MS Excel

MS Access

Visio

JIRA

SharePoint

MS Project

Job description

Medical Content Analyst

The Medical Content Analyst researches and identifies Medicare, Medicaid, and other medical coding and billing documents to determine claim denial criteria for our automated claims editing solution used by medical insurance payers across the United States. Clinical content may include additions, deletions, or updates to diagnosis codes, procedure codes, age minimums & maximums, quantity limitations, place of service limitations, and other clinical content criteria.

Analyst responsibilities include providing written and oral presentations to the Medical Director and other clinical colleagues to reach consensus on proposed denial criteria, offering clinical content support to our customers as needed, performing data entry of clinical content updates into the database, and solving issues related to inpatient coding or ICD-10-CM coding conventions/guidelines for inclusion or exclusion within Lyric business rules. The analyst will make recommendations within the software to deny diagnosis, age, or other criteria on medical claims based on coding guidelines, affecting how claims are processed for various insurance payers.

Responsibilities

• Provide written and oral presentations to Medical Director and other clinical colleagues to obtain consensus on proposed denial criteria.
• Offer clinical content support to customers as needed.
• Perform data entry of clinical content updates into the database.
• 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.

Qualifications

• BS Nursing or equivalent required.
• Minimum of 4 years' 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 required.
• Experience in denial management or claim review management is a plus.
• Excellent verbal and written communication skills enabling effective communication both internally and externally.
• Proficiency with software applications including 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) is required.