Senior Medical Content Analyst

MicroSourcing International; Manila; On-site; PHP 900,000 - 1,500,000; Full time

Benefits offered by this job

Sign-On Bonus (1 month salary)

Healthcare coverage on day one

Performance bonuses

Job summary

MicroSourcing is seeking a Senior Medical Content Analyst to analyze payer policies and maintain coding logic for US health plans. You will present findings to Medical Directors and support clinical decision-making, while ensuring accurate data entry and coding quality in a remote work setup.

The role requires a BSN, active CPC/CCS-P, and 4+ years of US payer experience, with strong ICD-10-CM/CPT/HCPCS knowledge and MS Office proficiency.

Qualifications

• BSN with active nursing license.
• Active CPC or CCS-P certification.
• 4+ years US healthcare payer experience.
• Strong knowledge of ICD-10-CM, CPT, HCPCS and coding guidelines.

Responsibilities

• Analyze Medicare, Medicaid, and commercial policies for denial criteria.
• Maintain and update clinical logic for ICD-10-CM, CPT, HCPCS.
• Prepare summaries and presentations for Medical Directors.
• Interpret coding conventions and inpatient guidelines.
• Data entry of clinical content updates using JIRA/SharePoint/MS Access/Excel.
• Provide coding support to US health plan clients and internal teams.

Skills

US healthcare payer experience

Nursing background

CPC/CCS-P certification

ICD-10-CM/CPT/HCPCS knowledge

MS Office proficiency

Education

BSN

Tools

JIRA

SharePoint

MS Access

Excel

Visio

MS Project

Job description

Discover your 100% YOU with MicroSourcing!

Sign-On Bonus: Earn a bonus equivalent to 1 month's salary upon joining!

Position: Senior Medical Content Analyst

Work setup & shift: Work From Home | Night Shift

Why join MicroSourcing?

• 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.

Your Role

As a Senior Medical Content Analyst, you will:

• Clinical Policy Research: Analyze Medicare, Medicaid, and commercial billing policies to identify claim denial criteria, coverage limitations, age/quantity thresholds, and place-of-service rules.
• Claim Engine Rule Optimization: Maintain and update clinical logic within database platforms, managing code additions, deletions, and edits for ICD-10-CM, CPT, and HCPCS.
• Medical Director Presentations: Prepare written summaries and conduct oral presentations for Medical Directors (physicians) and clinical stakeholders to secure consensus on proposed denial rules.
• Complex Coding Resolution: Interpret complex ICD-10-CM conventions, inpatient coding guidelines, and coding edits to resolve ambiguous business rule requirements.
• Database Entry & System Maintenance: Perform precise data entry of clinical content updates, policy changes, and coding logic using JIRA, SharePoint, MS Access, and Excel.
• Client & Operational Support: Provide clinical coding support and rule explanations to US health plan clients and internal product teams.

What You Need

Non-negotiables

• Educational Foundation: Bachelor of Science in Nursing (BSN)
• Active Professional Coding Certification: Active AAPC CPC (Certified Professional Coder) or AHIMA CCS-P (Certified Coding Specialist – Physician-based).
• 4+ Years US Healthcare Payer Experience: Minimum 4 years of hands-on experience in medical billing, coding, claims processing, chart auditing, or appeals with US health insurance payers.
• Clinical Coding & Policy Expertise: Deep understanding of ICD-10-CM, CPT, HCPCS, NCCI edits, LCDs/NCDs, and inpatient coding guidelines.
• Technical & Database Proficiency: Demonstrated skill with MS Office (Word, Excel, Access), Visio, JIRA, and database tracking systems.

Preferred Skills/expertise

• Prior experience in denial management, utilization review, or claim audit management for US health insurance payers.
• Familiarity with enterprise payment integrity platforms or automated claim editing software.
• Practical knowledge of MS Visio for workflow mapping and MS Project for content tracking.
• Advanced presentation and stakeholder engagement skills for collaborating with physician leadership.

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