Medical Content Analyst

4 weeks ago

Taguig, Philippines MicroSourcing Full time

The Medical Content Analyst will independently research and identify new clinical content areas of claims editing, by reviewing specialty societies, peer reviewed medical journals, etc., to recommend new savings opportunities for Lyric customers. The Medical Content Analyst will evaluate analytics reports and medical claims to identify new claims editing opportunities. The ideal candidate should be self-directed, possess a proactive mindset, and be able to contribute to the content topics backlog for editing consideration. This role will also function as a subject matter expert for current claims auditing and medical coding scenarios to expand editing outcomes. This role will provide content knowledge transfer to colleagues for rule development.
Responsibilities:
  • Research and identify new clinical content concepts by reviewing specialty societies articles, peer reviewed medical journals, etc., to recommend new editing opportunities for Lyric customers.
  • Analyze claims and analytics reports to identify new editing opportunities.
  • Function as a subject matter expert for coding scenarios to enhance editing outcomes
  • Perform content knowledge transfer to colleagues for rule development.
  • Responsible for making recommendations within the software for the denial of diagnosis, age, or other criteria on medical claims based on coding guidelines. This task will impact how claims are processed for certain individuals who are members of various insurance payers.
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

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