Clinical Content Specialist
17 hours ago
The Medical Coder will be responsible for conducting research and identifying Medicare, Medicaid, and other medical coding and billing documents to identify claim denial or covered criteria (clinical content) for an automated claims editing solution. This solution is utilized by medical insurance payers across the United States.
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.
Responsibilities:- Conduct research and identify relevant medical coding and billing documents to inform clinical content decisions.
- Collaborate with physicians and clinical colleagues to obtain consensus on proposed denial criteria through written and oral presentations.
- Provide clinical content support to customers as needed.
- Enter data related to clinical content updates into a database, as required.
- Analyze ICD-10-CM coding conventions/guidelines for inclusion or exclusion within business rules.
- A bachelor's degree in nursing and active RN licensure are necessary.
- Either AHIMA Certified Coding Specialist - Physician (CCS-P) or AAPC Certified Professional Coder (CPC) certification, combined 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 is beneficial.
- Denial management or claim review management experience can be advantageous.
- Excellent communication skills enable effective interaction with all business areas.
- Proficiency in MS Office applications is required.
- Availability to work night shifts may be a requirement.
This role offers a challenging opportunity to contribute to a dynamic team and make a meaningful impact on healthcare.
MicroSourcing prioritizes inclusivity and celebrates diverse backgrounds, fostering growth opportunities for every team member.
Learn more about this opportunity and how it aligns with your skills and interests.
Remote work arrangements are available, enabling flexibility and convenience.
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