Clinical Documentation Specialist

2 days ago

Cainta, Calabarzon, Philippines beBeeCoding Full time ₱40,000 - ₱60,000
Medical Coding Specialist

As a Medical Coding Specialist, you will play a vital role in conducting thorough research and identifying Medicare, Medicaid, and other medical coding and billing documents to determine claim denial or covered criteria for our automated claims editing solution. This solution is utilized by medical insurance payers across the United States, enabling accurate and efficient processing of claims.

Key Responsibilities:
  • Conduct comprehensive research and identify relevant Medicare, Medicaid, and other medical coding and billing documents to determine claim denial or covered criteria.
  • Develop and present written and oral presentations to obtain consensus on proposed denial criteria, ensuring alignment with industry standards and regulations.
  • Provide clinical content support to customers as needed, addressing their questions and concerns in a professional and timely manner.
  • Perform data entry of clinical content updates into database, maintaining accuracy and efficiency in the process.
  • Solve complex problems 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:
  • Bachelor's Degree in Nursing or related field.
  • 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 are required.
  • Previous experience working with US health insurance payers in claims, appeals, or coding capacity is also required.
  • 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 MS Office Applications.
  • Amenable to Night Shift.
  • Amenable to Work From Home Set-Up.
Benefits:

This role offers a unique opportunity to work with a leading healthcare organization, contributing to the development of innovative solutions that improve patient care and outcomes. As a Medical Coding Specialist, you will have access to cutting-edge technology and training, enabling you to excel in your career and make a meaningful impact.

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