Clinical Content Specialist

1 day ago

Quezon City, National Capital Region, Philippines beBeeHealthcare Full time $70,000 - $90,000

Job Title: Healthcare Content Specialist

About the Role

This is a highly specialized role that involves conducting research 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. 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.

Key Responsibilities
  • Conduct thorough research on Medicare, Medicaid, and other medical coding and billing documents to identify claim denial or covered criteria.
  • Collaborate with Medical Director (physicians) and other clinical colleagues to obtain consensus on proposed denial criteria through written and oral presentations.
  • Provide expert clinical content support to customers as needed.
  • Perform data entry of clinical content updates into database, as required.
  • Analyze problems related to the interpretation of inpatient coding or ICD-10-CM coding conventions/guidelines for inclusion or exclusion within Lyric business rules.
Required Skills and Qualifications

To be successful in this role, you will need to possess the following skills and qualifications:

  • Bachelor's Degree in Nursing with an Active RN (PRC) 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.
  • Excellent Communication Skills (verbal and written), enabling effective communication with all areas of the business.
  • Proficient in using MS Office applications.
  • Able to work night shifts.
About Us

We are a global provider of managed services with over 9,000 professionals across 13 delivery centers. Our inclusive culture celebrates authentic selves and strives to foster growth and opportunity for every team member.

We offer a range of benefits and opportunities for professional development.

Contact us today to learn more about this exciting opportunity

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