Content Expert for Healthcare Solutions

4 days ago

Manila, National Capital Region, Philippines beBeeClinical Full time ₱600,000 - ₱1,000,000

Healthcare Content Specialist Role Overview

The position involves conducting research to identify medical coding and billing documents for an automated claims editing solution. This solution is utilized by medical insurance payers across the United States.

The successful candidate will be responsible for analyzing clinical content, including additions, deletions, or updates to diagnosis codes, procedure codes, age minimums & maximums, quantity limitations, place of service limitations, and other clinical content criteria.

Key Responsibilities:
  • Conduct thorough research to identify relevant medical coding and billing documents.
  • Analyze clinical content to inform updates to the automated claims editing solution.
  • Provide written and oral presentations to stakeholders to obtain consensus on proposed denial criteria.
  • Offer clinical content support to customers as needed.
  • Enter data into a database for clinical content updates.
  • 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 Skills and Qualifications:
  • Bachelor's Degree in Nursing with active RN license.
  • AHIMA Certified Coding Specialist - Physician (CCS-P) or AAPC Certified Professional Coder (CPC).
  • No less than 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.
  • Denial management or claim review management experience is advantageous.
  • Excellent verbal and written communication skills for effective collaboration with all areas of the business.
  • Proficiency in MS Office applications.
  • Willingness to work night shifts.
About the Opportunity:

This is a remote opportunity with flexible scheduling options.

The ideal candidate will have excellent analytical skills and the ability to effectively communicate complex ideas to various stakeholders.

This role offers a dynamic and challenging work environment with opportunities for growth and professional development.

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