Medical Coding Specialist

2 weeks ago

Imus, Calabarzon, Philippines beBeeClinical Full time ₱800,000 - ₱1,200,000
Job Overview

This role involves conducting research to identify medical coding and billing documents related to claim denial or covered criteria for an automated claims editing solution.

The clinical content will include additions, deletions, or updates to diagnosis codes, procedure codes, age minimums & maximums, quantity limitations, place of service limitations, and other clinical content criteria.

Duties and Responsibilities
  • Conduct thorough research on Medicare, Medicaid, and other medical coding and billing documents to identify claim denial or covered criteria (clinical content) for our automated claims editing solution.
  • Prepare written and oral presentations to medical directors and other clinical colleagues to obtain consensus on proposed denial criteria.
  • Provide clinical content support to customers as needed.
  • Enter data into a database to update clinical content, as necessary.
  • Solve problems related to the interpretation of inpatient coding or ICD-10-CM coding conventions/guidelines for inclusion or exclusion within business rules.
Required Qualifications
  • A bachelor's degree in nursing with an active RN license.
  • Professional certifications such as CCS-P or CPC, along 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 claims, appeals, or coding capacities.
  • Denial management or claim review management experience is highly valued.
  • Excellent verbal and written communication skills for effective collaboration across all business areas.
  • Proficiency in MS Office applications.
  • A willingness to work non-traditional hours, if required.
About This Opportunity

This position requires a skilled professional with expertise in medical coding and billing. The ideal candidate will have strong analytical skills, excellent communication abilities, and a proven track record of delivering high-quality results under tight deadlines.

We are committed to providing a supportive work environment that fosters growth and opportunity for every team member. If you're passionate about making a difference in the healthcare industry, we encourage you to apply for this exciting opportunity.

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