Clinical Content Expert

2 days ago

Manila, National Capital Region, Philippines beBeeAnalyst Full time $90,000 - $120,000

The Medical Content Analyst role involves independent research and identification of new clinical content areas for claims editing.

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Key Responsibilities:

  • Evaluate analytics reports and medical claims to identify new claims editing opportunities
  • Contribute to the content topics backlog for editing consideration
  • Function as a subject matter expert for current claims audition and medical coding scenarios to expand editing outcomes
  • Provide content knowledge transfer to colleagues for rule development
  • Solve problems related to the interpretation of inpatient coding or ICD-10-CM coding conventions/guidelines for inclusion or exclusion with business rules
  • Make recommendations within the software for the denial of diagnosis, age, or other criteria on medical claims based on coding guidelines

Requirements:

  • BS Nursing, BS Pharmacy, or equivalent is required; 4 years' experience in medical billing, coding, claims processing, bill review/auditing is also required
  • Previous experience working with US health insurance payers in a claims, appeals, or coding capacity is necessary
  • Excellent communication skills (verbal and written) enabling effective communication both internally and externally are required
  • Demonstrated proficiency with various software applications, including MS Word, MS Excel, MS Access, Visio, JIRA, SharePoint, and MS Project are beneficial
  • AHIMA Certified Coding Specialist – Physician (CCS-P) or AAPC Certified Professional Coder (CPC) certification is mandatory

Desirable Qualifications:

  • Ability to influence and direct thoughts and actions to successfully reach goals
  • Embracing challenges and persisting in the face of setbacks
  • Providing clear, balanced advice/counsel on strategic and complex management, product, and market issues
  • Results-oriented style with analytical ability and problem-solving skills
  • Thriving in a dynamic, fast-paced environment and leading others through change

Lyrical Culture:

  • Lyric strives to maximize the productivity and performance of employees by fostering a winning team spirit and high personal accountability
  • Everyone is encouraged to respond regardless of lifestyle, belief, or generational diversity

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