Clinical Content Strategist

24 hours ago

Bacoor, Calabarzon, Philippines beBeeCoding Full time $100,000 - $120,000
Healthcare Content Specialist Role Overview

This is a unique opportunity to leverage your expertise in medical coding and billing to drive the development of our automated claims editing solution.

The successful candidate will be responsible for conducting thorough research and analysis of Medicare, Medicaid, and other relevant documents to identify claim denial or covered criteria (clinical content) that can enhance our solution's effectiveness.

Key Responsibilities:
  • Conduct comprehensive research and analysis of medical coding and billing documents to identify clinical content that supports our automated claims editing solution.
  • Develop written and oral presentations to obtain consensus from clinical colleagues on proposed denial criteria.
  • Provide expert clinical content support to customers as needed.
  • Perform data entry of clinical content updates into our database as required.
  • Apply problem-solving skills to interpret inpatient coding or ICD-10-CM coding conventions/guidelines for inclusion or exclusion within business rules.
Required Qualifications:
  • Bachelor's Degree in Nursing with an active RN license.
  • AHIMA Certified Coding Specialist - Physician (CCS-P) or AAPC Certified Professional Coder (CPC) certification.
  • 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 is advantageous.
  • Experience in denial management or claim review management is beneficial.
  • Excellent communication skills enabling effective collaboration with all areas of the organization.
  • Proficiency in MS Office applications is essential.

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