Clinical Content Expert

3 days ago

Caloocan City, National Capital Region, Philippines beBeeCoding Full time $60,000 - $98,346
Job Title: Healthcare Content SpecialistOverview of the Position

The Healthcare Content Specialist occupies a pivotal role within our organization, working on an automated claims editing solution utilized by medical insurance payers across the United States.

Responsibilities and Key Tasks
  • Conduct in-depth research to identify Medicare, Medicaid, and other medical coding and billing documents related to claim denial or covered criteria (clinical content).
  • Prepare and present written and oral presentations to physicians and clinical colleagues to obtain consensus on proposed denial criteria.
  • Provide clinical content support to customers as needed.
  • Perform data entry of clinical content updates into our database.
  • Resolve problems related to ICD-10-CM coding conventions/guidelines for inclusion or exclusion within our business rules.
Requirements
  • Bachelor's Degree in Nursing with 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.
  • Denial management or claim review management experience is advantageous.
  • Excellent Communication Skills (verbal and written), enabling effective communication with all areas of the organization.
  • Proficient in using MS Office applications.
  • Flexibility to work night shifts.

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