Chief Clinical Coding Specialist

2 days ago

Marikina City, National Capital Region, Philippines beBeeClinical Full time ₱60,000 - ₱80,000
Medical Coder Job Description

The Medical Coder will be responsible for conducting in-depth research and identifying Medicare, Medicaid, and other medical coding and billing documents to pinpoint claim denials or covered criteria (clinical content) for our automated claims editing solution.

This solution is utilized by medical insurance payers across the United States. The clinical content may include additions, deletions, or updates to diagnosis codes, procedure codes, age minimums & maximums, quantity limitations, place of service limitations, and other clinical content criteria.

Key Responsibilities:

  • Conduct thorough research and identify Medicare, Medicaid, and other medical coding and billing documents to pinpoint claim denials or covered criteria (clinical content) for our automated claims editing solution.
  • Provide written and oral presentations to senior medical professionals and other clinical colleagues to obtain consensus on proposed denial criteria.
  • Offer clinical content support to our clients as needed.
  • Enter data related to clinical content updates into a database, as required.
  • Solve complex problems related to the interpretation of inpatient coding or ICD-10-CM coding conventions/guidelines for inclusion or exclusion within our business rules.

Requirements:

  • A bachelor's degree in nursing.
  • An active RN license.
  • Certification as an AHIMA Certified Coding Specialist - Physician (CCS-P) or AAPC Certified Professional Coder (CPC).
  • At least five years of experience in CPT coding, HCPCS, medical billing, claim denials, and/or chart review/auditing are required.
  • Previous experience working with US health insurance payers in a claims, appeals, or coding capacity is also required.
  • Experience in denial management or claim review management is advantageous.
  • Excellent communication skills (verbal and written) enabling effective communication with all areas of the business.
  • Proficiency in using Microsoft Office applications.
  • Ability to work night shifts and adapt to a remote work setup.

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