Outpatient Medical Coder [WFH]

Swift Up; Taguig; Remote; PHP 600,000 - 900,000; Full time

Job summary

Swift Up in the Philippines is looking for a Medical Content Analyst 3 to research Medicare, Medicaid, and other medical coding and billing documents to identify denial criteria for our automated claims editing solution used by US payers.

You will present findings to Medical Director and clinical colleagues to gain consensus on denial criteria, provide customer support, and perform data entry of clinical content updates.

Qualifications

• BS Nursing or BS Pharmacy or equivalent required.
• 4 years experience in medical billing, coding, claims processing, bill and/or chart review/auditing required.
• Previous 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) enabling effective communication with all areas of the business and externally.
• Demonstrated proficiency with MS Word, MS Excel, MS Access, Visio, JIRA, SharePoint; 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 (clinical content) for our 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 our customers as needed.
• Perform data entry of clinical content updates into database, as needed.
• Solve problems related to interpretation of inpatient coding or ICD-10-CM conventions for inclusion or exclusion within Lyric business rules.

Skills

Communication skills

MS Word

MS Excel

MS Access

Visio

JIRA

SharePoint

MS Project

Education

BS Nursing or BS Pharmacy or equivalent

Tools

MS Word

MS Excel

MS Access

Visio

JIRA

SharePoint

MS Project

Job description

About the role

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, minimums & maximums, quantity limitations, place of service limitations and other clinical content criteria.

Key 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

• 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 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

About you

• BS Nursing, BS Pharmacy or equivalent required

• 4 years experience in medical billing, coding, claims processing, bill and/or chart review/auditing required

• Previous 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) 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) required