Medical Content Expert

1 day ago

Mabalacat, Central Luzon, Philippines beBeeClinicalContent Full time ₱2,000,000 - ₱2,500,000

Healthcare Content Specialist Role Overview

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This role involves conducting research to identify Medicare, Medicaid, and other medical coding and billing documents to determine claim denial or covered criteria for an automated claims editing solution. The solution is utilized by medical insurance payers across the United States.

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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.

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Responsibilities:

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  • Research and identify Medicare, Medicaid, and other medical coding and billing documents to determine claim denial or covered criteria.">
  • Provide written and oral presentations to Medical Directors (physicians) and other clinical colleagues to obtain consensus on proposed denial criteria.">
  • Provide clinical content support to customers as needed.">
  • Perform data entry of clinical content updates into a database, as needed.">
  • Solve problems related to the interpretation of inpatient coding or ICD-10-CM coding conventions/guidelines for inclusion or exclusion within business rules.">
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Required Skills and Qualifications:

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  • Bachelor's Degree in Nursing, with an active RN license.">
  • AHIMA Certified Coding Specialist - Physician (CCS-P) or AAPC Certified Professional Coder (CPC), with at least 5 years of experience in CPT Coding, HCPCS, Medical Billing, Claims Denials, and/or Chart Review/Auditing.">
  • Previous experience working with US health insurance payers in a claims, appeals, or coding capacity.">
  • Experience in denial management or claim review management is a plus/advantage.">
  • Excellent Communication Skills (verbal and written), enabling effective communication with all areas of the business.">
  • Proficient in using MS Office applications.">
  • Able to work night shifts.">
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About Us:

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We are a global provider of managed services, with over 9,000 professionals across 13 delivery centers. Our inclusive culture embraces individuals of all races, genders, ethnicities, abilities, and backgrounds.

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We celebrate authentic selves and strive to foster growth and opportunity for every team member.

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Contact Information:

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Please visit our website for more information.

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Additional Details:

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Seniority level: Mid-Senior level

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Employment type: Full-time

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Job function: Health Care Provider and Information Technology

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Industries: Outsourcing and Offshoring Consulting

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Location: Remote (Work From Home)

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