Healthcare Data Analyst

10 hours ago

Cavite City, Calabarzon, Philippines beBeeClinical Content Full time $50,000 - $75,000

We are seeking a skilled Medical Coding Specialist to join our team. As a Medical Coding Specialist, you will be responsible for conducting thorough research and analysis of Medicare, Medicaid, and other medical coding and billing documents to identify claim denial or covered criteria for our automated claims editing solution.

This solution is utilized by medical insurance payers across the United States, and your clinical content expertise will play a critical role in identifying additions, deletions, or updates to diagnosis codes, procedure codes, age minimums & maximums, quantity limitations, place of service limitations, and other clinical content criteria.

Responsibilities:
  • Conduct research and analysis of medical coding and billing documents to identify claim denial or covered criteria.
  • Provide written and oral presentations to healthcare professionals to obtain consensus on proposed denial criteria.
  • Support customers with clinical content needs as required.
  • Perform data entry of clinical content updates into databases as needed.
  • Solve complex problems related to the interpretation of inpatient coding or ICD-10-CM coding conventions/guidelines for inclusion or exclusion within business rules.
Required Qualifications:
  • Bachelor's Degree in Nursing, with an active RN license.
  • AHIMA Certified Coding Specialist - Physician (CCS-P) or AAPC Certified Professional Coder (CPC).
  • 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.
  • Excellent communication skills, enabling effective collaboration with all areas of the organization.
  • Proficient in using MS Office applications.
  • Able to work flexible hours, including nights.
About Our Organization:

We are a global provider of managed services, with a commitment to inclusivity and growth. Our culture values diversity, equity, and opportunity for all team members.

We strive to foster a work environment that supports career development and well-being. For more information, visit our website.

Additional Details:

Seniority level: Mid-Senior level

Employment type: Full-time

Job function: Health Care Provider and Information Technology

Industries: Outsourcing and Offshoring Consulting

Location: Remote (Work From Home) / Flexible hours available

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