Medical Content Analyst - Coding & Denials (Night Shift)

MicroSourcing; Philippines; On-site; PHP 600,000 - 900,000; Full time

Benefits offered by this job

Competitive Rewards

Job summary

MicroSourcing in Taguig, Metro Manila, Philippines is seeking a Medical Content Analyst 3 to research Medicare, Medicaid, and other medical coding documents to identify claim denial or covered criteria for our automated claims editing solution. The role requires collaboration with a Medical Director and clinicians to reach consensus on denial criteria.

You will provide clinical content support to customers and perform data entry of updates into our database, with a focus on inpatient coding and

Qualifications

• BS Nursing, BS Pharmacy or equivalent required.
• 4 years’ experience in medical billing, coding, claims processing, bill and/or chart review/auditing.
• Previous experience with US health insurance payers in a claims, appeals or coding capacity is required.
• AHIMA CCS-P or AAPC CPC certification is required.
• Experience in denial management or claim review management is a plus.
• Excellent communication skills (verbal and written) enabling effective internal and external communication.

Responsibilities

• Research Medicare, Medicaid, and other medical coding and billing documents to identify claim denial or covered criteria for the automated claims editing solution.
• 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 customers as needed.
• Perform data entry of clinical content updates into the database, as needed.
• Resolve problems related to interpretation of inpatient coding or ICD-10-CM guidelines for inclusion or exclusion within Lyric business rules.

Skills

Communication skills

Education

BS Nursing, BS Pharmacy or equivalent

Tools

MS Word

MS Excel

MS Access

Visio

JIRA

SharePoint

MS Project

Job description

Applicants from Visayas and Mindanao are encouraged to apply!

Discover your 100% YOU with MicroSourcing!

Position: Medical Content Analyst

Work setup & shift: Work From Home| Night Shift

Why join MicroSourcing?

You'll Have

• Competitive Rewards: Enjoy above-market compensation, healthcare coverage on day one, plus one or more dependents, paid time-off with cash conversion, group life insurance, and performance bonuses
• A Collaborative Spirit: Contribute to a positive and engaging work environment by participating in company-sponsored events and activities.
• Work-Life Harmony: Enjoy the balance between work and life that suits you with flexible work arrangements.
• Career Growth: Take advantage of opportunities for continuous learning and career advancement.
• Inclusive Teamwork: Be part of a team that celebrates diversity and fosters an inclusive culture.
  
  

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 interpration 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
  
  

About MicroSourcing

With over 9,000 professionals across 13 delivery centers, MicroSourcing is the pioneer and largest offshore provider of managed services in the Philippines.

Our commitment to 100% YOU

MicroSourcing firmly believes that our company's strength lies in our people's diversity and talent. We are proud to foster an inclusive culture that embraces individuals of all races, genders, ethnicities, abilities, and backgrounds. We provide space for everyone, embracing different perspectives, and making room for opportunities for each individual to thrive.

At MicroSourcing, equality is not merely a slogan – it's our commitment. Our way of life. Here, we don't just accept your unique authentic self - we celebrate it, valuing every individual's contribution to our collective success and growth. Join us in celebrating YOU and your 100%!

For more information, visit https://www.microsourcing.com/

• Terms & conditions apply