Senior Medical Content Analyst: AI-Driven Denials & Coding

TBC Corporation; Manila; On-site; PHP 600,000 - 900,000; Full time

Job summary

Lyric is a leader in healthcare decision intelligence. We deliver transparent, auditable insights across real-time claims workflows, helping health plans improve payment accuracy while maintaining control.

The ideal candidate has a nursing or pharmacy background, 5 years in medical billing/coding, and CCS-P/CPC certification. You will support clients, update coding criteria, and ensure adherence to guidelines in a fast-paced, collaborative environment.

Qualifications

• BS Nursing, BS Pharmacy or equivalent required.
• 5 years' experience in medical billing, coding, claims processing, bill and/or chart review/auditing; prior work with US health payers required.
• AHIMA CCS-P or AAPC CPC certification required.

Responsibilities

• Provide additions, deletions or updates to diagnosis codes, procedure codes, age min/max, quantity limitations and other clinical content criteria.
• Present findings to Medical Director and clinical colleagues to obtain consensus on denial criteria.
• Provide clinical content support to customers as needed.
• Enter clinical content updates into database as needed.
• Resolve issues related to inpatient coding and ICD-10-CM conventions for Lyric rules.
• Recommend coding-based denials for diagnoses, age, or other criteria per guidelines.

Skills

Communication skills

Analytical skills

Agile environment

Education

BS Nursing, BS Pharmacy or equivalent

Tools

MS Word

MS Excel

MS Access

Visio

JIRA

SharePoint

MS Project

Job description

Lyric is a leader in healthcare decision intelligence. We deliver transparent, auditable insights across real-time claims workflows, helping health plans improve payment accuracy while maintaining control.

The ideal candidate has a nursing or pharmacy background, 5 years in medical billing/coding, and CCS-P/CPC certification. You will support clients, update coding criteria, and ensure adherence to guidelines in a fast-paced, collaborative environment.