Clinical Content Specialist Role
2 days ago
This role is responsible for conducting research and identifying medical coding and billing documents to identify claim denial or covered criteria 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.
- Conduct research and identify Medicare, Medicaid, and other medical coding and billing documents to identify claim denial or covered criteria for our automated claims editing solution.
- Provide written and oral presentations to obtain consensus on proposed denial criteria.
- Support customers with clinical content as needed.
- Perform data entry of clinical content updates into database, as needed.
- Solve problems related to the interpretation of inpatient coding or ICD-10-CM coding conventions/guidelines for inclusion or exclusion within business rules.
- Bachelor's Degree in Nursing. Must have an Active RN 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.
- Excellent Communication Skills, enabling effective communication with all areas of the business.
- Proficient in using MS Office applications.
- Able to work night shifts.
With over 9,000 professionals across 13 delivery centers, we are a pioneer and largest offshore provider of managed services. Our inclusive culture celebrates individuals of all backgrounds and strives to foster growth and opportunity for every team member.
We offer a remote work environment with flexible scheduling options.
Seniority level: Mid-Senior level
Employment type: Full-time
Job function: Health Care Provider and Information Technology
Industries: Outsourcing and Offshoring Consulting
Location: Remote / Night Shift available
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