Clinical Data Specialist

8 hours ago

Batangas, Calabarzon, Philippines beBeeHealthcare Full time $21,600
Healthcare Analyst Position Summary:

We are seeking an experienced healthcare professional to support clinical and coding operations through accurate data analysis.

The ideal candidate will have a strong understanding of HCC coding, RAF scoring, and ICD-10 coding standards, as well as experience working with healthcare data sets such as claims, EMR, and encounter data.

The selected individual will be responsible for analyzing clinical data to identify opportunities for accurate Hierarchical Condition Categories (HCC) coding and Risk Adjustment Factor (RAF) optimization.

  • Key Responsibilities Include:
  • Analyzing clinical data to identify opportunities for accurate HCC coding and RAF optimization
  • Reviewing patient records, claims data, and provider documentation to ensure risk-adjusted coding accuracy
  • Collaborating with coding and clinical teams to support audit processes and data integrity
  • Generating reports and dashboards that support care management, risk adjustment, and quality improvement initiatives
  • Tracking performance metrics and highlighting trends or anomalies in healthcare data sets
  • Supporting compliance with CMS risk adjustment guidelines and payer-specific requirements
  • Maintaining documentation and data validation procedures to ensure consistent analysis
Requirements:
  • Minimum 2 years' experience in U.S. healthcare analytics, medical coding, or risk adjustment
  • Strong knowledge of HCC coding, RAF scoring, and ICD-10 coding standards
  • Experience working with healthcare data sets such as claims, EMR, and encounter data
  • Proficient in using tools like Excel, Google Sheets, and data visualization platforms
  • Familiarity with CMS guidelines and risk adjustment methodologies
  • Excellent analytical, organizational, and communication skills
  • Ability to work independently in a remote environment with minimal supervision
Preferred Qualifications:
  • Background in Nursing, Health Information Management, Public Health, or related fields
  • Certification in medical coding is a plus
  • Experience working with U.S. health plans, ACOs, or Medicare Advantage organizations

As a valued member of our team, you will enjoy the flexibility of remote work while making a measurable impact in improving patient care and data-driven clinical outcomes.

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