Senior Medical Content Analyst, Automatio

Manatal; Taguig; Hybrid; PHP 1,129,000 - 2,257,000; Full time

Job summary

Manatal seeks a Medical Content Analyst 3 to research Medicare/Medicaid coding and denial criteria for automated claims editing used by US payers. You will craft clinical content updates and support customers with complex coding questions, presenting findings to medical directors and clinicians.

Required BS Nursing or BS Pharmacy, 4 years in medical billing/coding, and CCS-P or CPC certification. Strong communication and software skills (Word/Excel/Access/Visio/JIRA/SharePoint) are essential.

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.
• Experience working with US health insurance payers in a claims, appeals or coding capacity preferred.
• AHIMA CCS-P or AAPC CPC certification required.

Responsibilities

• Research and identify Medicare, Medicaid, and other medical coding and billing documents to identify claim denial or covered criteria (clinical content).
• Provide written and oral presentations to Medical Director and 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.
• Resolve issues related to interpretation of inpatient coding or ICD-10-CM guidelines for Lyric business rules.

Job description

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