Medical Content Analyst

Color Philippines; Taguig; Híbrido; PHP 400.000 - 640.000; Jornada completa

Descripción de la vacante

Color Philippines is seeking a Medical Content Analyst 3 to research Medicare/Medicaid coding and other clinical content for our automated claims editing solution used by US payers.

You will review diagnosis and procedure codes, age limits, quantity and service constraints, and present findings to Medical Directors and clinicians to agree on denial criteria. You will also update databases and support customers as needed.

Formación

• BS Nursing, BS Pharmacy 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 claims, appeals or coding.
• Experience in denial management or claim review is a plus.
• AHIMA CCS-P or AAPC CPC certification required.

Responsabilidades

• Research Medicare, Medicaid and other medical coding/billing documents for denial or covered criteria.
• Provide written and oral presentations to Medical Director and colleagues to obtain consensus on denial criteria.
• Provide clinical content support to customers as needed.
• Perform data entry of clinical content updates into database.
• Solve problems related to inpatient coding and ICD-10-CM guidelines for Lyric business rules.

Conocimientos

Verbal communication

Written communication

Attention to detail

Research skills

Critical thinking

Educación

BS Nursing or Pharmacy or equivalent

AHIMA CCS-P

AAPC CPC

Herramientas

MS Word

MS Excel

MS Access

Visio

JIRA

SharePoint

MS Project

Descripción del empleo

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 (clinical content) for our automated claims editing solution. This solution is utilized by medical insurance payers across the United States.

The clinical content could include additions, deletions or updates to diagnosis codes, procedure codes, age minimums & maximums, quantity limitations, place of service limitations and other clinical content criteria. The Medical Content Analyst 3 will provide written and oral presentations to Medical Director (physicians) and other clinical colleagues to obtain consensus on proposed denial criteria. The Medical Content Analyst 3 will provide clinical content support to our customers as needed.

The Medical Content Analyst 3 will perform data entry of clinical content updates into database, as needed.

Responsibilities

• Research and identify Medicare, Medicaid, and other medical coding and billing documents to identify claim denial or covered criteria (clinical content) for our automated claims editing solution.

The clinical content could 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

• 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 databse, 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.
• 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