Senior Medical Coder – Denials & Clinical Content Expert

Prime Manpower Resources Development Inc; Taguig; On-site; PHP 450,000 - 600,000; Full time

Job summary

Prime Manpower Resources Development Inc is seeking a medically focused coder with strong US payer experience to review and update diagnosis and procedure codes, age limits, and other clinical criteria. You will present denial criteria to the Medical Director and collaborate with physicians.

The ideal candidate holds a BS in Nursing with 4 years in billing/coding roles and AHIMA CCS-P or AAPC CPC certification, and will support clients with coding guidance and software-based denial

Qualifications

• BS Nursing or equivalent required.
• 4 years’ experience in medical billing, coding, claims processing, bill and/or chart review/auditing; US payer experience required.
• Experience in denial management or claim review management is a plus.
• AHIMA CCS-P or AAPC CPC certification required.

Responsibilities

• Provide additions, deletions or updates to diagnosis codes, procedure codes, age minimums & maximums, quantity 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 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.

Skills

Excellent communication

Verbal and written communication

Problem solving

Education

BS Nursing

Tools

MS Word

MS Excel

MS Access

Visio

JIRA

SharePoint

MS Project

Job description

Prime Manpower Resources Development Inc is seeking a medically focused coder with strong US payer experience to review and update diagnosis and procedure codes, age limits, and other clinical criteria. You will present denial criteria to the Medical Director and collaborate with physicians.

The ideal candidate holds a BS in Nursing with 4 years in billing/coding roles and AHIMA CCS-P or AAPC CPC certification, and will support clients with coding guidance and software-based denial