Content Medicine Specialist
15 hours ago
The role of a Medical Content Specialist is pivotal in our organization, involving research and identification of medical coding and billing documents to support our automated claims editing solution. This solution benefits medical insurance payers across the United States by providing clinical content for claim denials or covered criteria.
Key Responsibilities- Research and identify Medicare, Medicaid, and other medical coding and billing documents to support our automated claims editing solution.
- Collaborate with medical directors and clinical colleagues to provide written and oral presentations on proposed denial criteria.
- Provide clinical content support to customers as needed.
- Perform data entry of clinical content updates into our database.
- Solve problems related to inpatient coding, ICD-10-CM coding conventions/guidelines, and Lyric business rules.
- Bachelor's Degree in Nursing and 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.
- Excellent Communication Skills and proficiency in MS Office applications.
This is a mid-senior level position that requires strong analytical and communication skills. The ideal candidate will have experience in denial management or claim review management and be proficient in using MS Office applications.
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