Clinical Content Specialist

1 day ago

Manila, National Capital Region, Philippines beBeeCoding Full time $90,000 - $110,000

Healthcare professionals with expertise in medical coding and billing are sought after to join our team.

Job Description

As a key member of our clinical content team, you will be responsible for researching and identifying Medicare, Medicaid, and other medical coding and billing documents to identify claim denial or covered criteria (clinical content) for our automated claims editing solution.

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.

You will provide written and oral presentations to Medical Directors (physicians) and other clinical colleagues to obtain consensus on proposed denial criteria.

Additionally, you will provide clinical content support to our customers as needed and perform data entry of clinical content updates into database, as required.

Required Skills and Qualifications
  • Bachelor's Degree in Nursing. Must have an Active RN (PRC) 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 a plus/advantage.
  • Excellent Communication Skills (verbal and written), enabling effective communication with all areas of the business.
  • Proficient in using MS Office applications.
  • Able to work on night shifts.
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