Medical Coder Analyst (RN with CPC) / Night Shift / WFH Set Up

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Position: Medical Content Analyst
Location: BGC, Taguig City
Work Set-up & Shift: Work From Home

Position Summary:

The Medical Content Analyst will be responsible in conducting research and identifying Medicare, Medicaid, and other medical coding and billing documents to identify claim denial 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 could include additions, deletions or updates to diagnosis codes, procedure codes, age minimums & maximums, quantity limitations, place of service limitations and other clinical content criteria.

Duties and Responsibilities:

Research and identify Medicare, Medicaid, and other medical coding and billing documents to identify claim denial or covered criteria (clinical content) for our automated claims editing solution.
Provide written and oral presentations to Medical Director (physicians) and other clinical colleagues to obtain consensus on proposed denial criteria.
Provide clinical content support to our customers as needed
Perform data entry of clinical content updates into database, as needed
Solve problems related to the interpretation of inpatient coding or ICD-10-CM coding conventions/guidelines for inclusion or exclusion within Lyric business rules.

Required Qualifications:

Bachelor's Degree in Nursing.
Must have an Active RN (PRC) License.
Must be an AHIMA Certified Coding Specialist - Physician (CCS-P) or AAPC Certified Professional Coder (CPC).
At least 5 years of experience in the areas of CPT Coding, Medical Billing, Claims Processing and 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 a plus/advantage.
Excellent Communication Skills (verbal and written) enabling effective communication with all areas of the business.
Proficient in using MS Office Applications.
Amenable to Work on Night Shift.
Amenable to Work From Home Set-Up.