Urgent Hiring - Clinical Claims & Coding Specialist

Manpower Outsourcing Services, Inc.; Manila; On-site; PHP 480,000 - 720,000; Full time

Job summary

Manpower Outsourcing Services, Inc. in Manila, Philippines seeks a clinical coding specialist to develop and update criteria and review ICD-10-CM guidelines to support accurate medical claims denial rules.

You will present proposed denial criteria to Medical Directors and clinical teams to obtain consensus. The role provides clinical coding and claims support to customers and internal stakeholders, and requires maintaining clinical content updates in the database while recommending denial

Qualifications

• Proven experience with US healthcare insurance payers in claims, appeals, coding, or denial management.
• Strong knowledge of ICD-10-CM coding conventions and guidelines, medical claims review, and clinical criteria.
• Excellent written and verbal communication skills; proficient with MS Office and healthcare applications.

Responsibilities

• Develop and update clinical and coding criteria, including diagnosis/procedure codes, patient eligibility criteria, quantity limits, and place-of-service requirements.
• Review ICD-10-CM and inpatient coding guidelines to support accurate medical claims denial rules and business logic.
• Present proposed denial criteria to Medical Directors and clinical teams to obtain clinical consensus and approval.
• Provide clinical coding and claims support to customers and internal stakeholders, resolving coding-related inquiries and issues.
• Enter, maintain, and validate clinical content updates in the database while recommending appropriate denial criteria for medical claims.

Skills

ICD-10-CM knowledge

US payer experience

Communication skills

Claims processing experience

Education

BS Nursing or equivalent

Tools

JIRA

SharePoint

MS Access

Visio

Job description

• Develop and update clinical and coding criteria, including diagnosis/procedure codes, patient eligibility criteria, quantity limits, and place-of-service requirements.




• Review ICD-10-CM and inpatient coding guidelines to support accurate medical claims denial rules and business logic.




• Present proposed denial criteria to Medical Directors and clinical teams to obtain clinical consensus and approval.




• Provide clinical coding and claims support to customers and internal stakeholders, resolving coding-related inquiries and issues.




• Enter, maintain, and validate clinical content updates in the database while recommending appropriate denial criteria for medical claims.

Skills and requirements:

• BS Nursing or equivalent, with at least 4 years of experience in medical billing, coding, claims processing, chart review, or medical auditing.




• Proven experience working with US healthcare insurance payers, particularly in claims, appeals, coding, or denial management.




• Strong knowledge of ICD-10-CM coding conventions and guidelines, medical claims review, and clinical criteria.




• CPC (AAPC) or CCS-P (AHIMA) certification is required.




• Excellent written and verbal communication skills, with proficiency in MS Office and healthcare/business applications such as JIRA, SharePoint, MS Access, or Visio.