Medical Content Expert

20 hours ago


Baguio City, Cordillera, Philippines beBeeClinical Full time ₱1,100,000 - ₱1,350,000
Job Opportunity

Healthcare Content Specialist Role

This role involves working as a Medical Coder, conducting research and identifying medical coding and billing documents to optimize an automated claims editing solution.

The clinical content specialist will be responsible for ensuring accurate and up-to-date diagnosis codes, procedure codes, age minimums & maximums, quantity limitations, place of service limitations, and other clinical content criteria are added, deleted, or updated in the system.

Key Responsibilities:
  • Conduct thorough research on Medicare, Medicaid, and other medical coding and billing documents to identify claim denial or covered criteria for our automated claims editing solution.
  • Collaborate with physicians and other clinical colleagues to obtain consensus on proposed denial criteria through written and oral presentations.
  • Provide timely and accurate clinical content support to customers as needed.
  • Perform data entry of clinical content updates into databases, as required.
  • Investigate and resolve issues related to the interpretation of inpatient coding or ICD-10-CM coding conventions/guidelines for inclusion or exclusion within business rules.
Required Skills and Qualifications:
  • Active RN (PRC) license and Bachelor's Degree in Nursing.
  • Certified Coding Specialist - Physician (CCS-P) or Certified Professional Coder (CPC) 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 a claims, appeals, or coding capacity is essential.
  • Experience in denial management or claim review management is advantageous.
  • Excellent verbal and written communication skills enabling effective collaboration with all areas of the business.
  • Proficiency in MS Office applications.
  • Ability to work night shifts.
Requirements

As a clinical content specialist, you must have strong analytical and problem-solving skills, along with excellent communication skills.

You should be able to work effectively in a team environment and have a strong attention to detail.

If you are passionate about delivering high-quality patient care and possess the necessary skills and qualifications, we encourage you to apply for this exciting opportunity.



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