Medical Content Specialist
7 days ago
The role of Medical Content Specialist involves research and identification of Medicare, Medicaid, and other medical coding and billing documents to identify claim denial or covered criteria for an automated claims editing solution. This solution is utilized by medical insurance payers across the United States.
Responsibilities- Conduct research and identify relevant documents to determine claim denial or covered criteria.
- Provide written and oral presentations to obtain consensus on proposed denial criteria.
- Offer clinical content support to customers as needed.
- Enter data related to clinical content updates into a database.
- Analyze inpatient coding and ICD-10-CM coding conventions/guidelines for inclusion/exclusion within business rules.
- 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 beneficial.
- Excellent communication skills for effective interaction with all areas of the organization.
- Proficient in MS Office applications.
- Ability to work night shifts.
This mid-senior level position is a full-time remote opportunity with a night shift available.
The ideal candidate will possess strong analytical and communication skills, along with a deep understanding of medical coding and billing principles.
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