Medical Coder (RN w/ CPC/AAPC) | PERM NIGHT SHIFT, TEMP WFH | BGC

  • Salary ₱18,000 - ₱22,000 / Monthly
  • Shift Full Time
  • Job Qualifications Professional License
  • Job experience 1 Year

Job Description

Position Summary (Purpose of job):

The Clinical Content Analyst/Developer researches, analyzes and creates clinical content for the business rules for Change Healthcare’s Clinical Claims Management (CCM). The CCM Product Line is a fast-paced environment with contractually driven quarterly deliverables. The CCM products are utilized by payer organizations to augment claims management systems, by electronically auditing medical claims, for accurate processing of both professional and facility claims. The role of the Analyst/Developer is to provide comprehensive and in-depth research, analysis and clinical content development of new and revised clinical content to be offered in existing or new business rules, to expand the CCM suite of offerings.

Clinical content includes but is not limited to CPT codes, ICD-10-CM diagnosis codes, HCPCS codes, POS codes, DRG’s, APC’s and other code sets and the translation of written clinical information into auditable clinical content.

Content development is defined as the identification of a clinical term, surgical procedure or medical condition and translating it into a procedure code, diagnosis code or any other code set element as appropriate.

In addition, the Analyst/Developer is responsible for clearly and concisely articulating any clinical content changes that are recommended by the Analyst/Developer, as needed. This discussion would occur during weekly team meetings or other clinical content meetings where discussion of clinical content would be required.

Key Responsibilities:

1. Research, analyze and review clinical content data sources to create update, add or delete clinical content (clinical content meaning CPT, HCPCS, ICD-10-CM, ICD-10-PCS, & all other code sets) opportunities. The Analyst/Developer is responsible for the creation and development of the clinical content to support new and existing CXT business rules.

Clinical Content sources includes but is not limited to:

·       Medicare Claims Processing manual
·       CMS transmittals
·       AMA publications
·       CPT changes and new code updates
·       HCPCS code updates,
·       NCCI policy manuals,
·       Medicaid Policy Edit & Design manuals
·       ICD-10-CM diagnosis code updates
·       ICD-10-PCS procedure code updates
·       National Coverage Determinations (NCDs)
·       Local Coverage Determinations (LCDs)
·       State Medicaid manuals, bulletins, banners & publications
·       Other 3rd party clinical content sources

The Clinical Content Analyst/Developer is responsible for reviewing all clinical content sourcing documentation for added content, revised content or deleted clinical content.

The Clinical Content Analyst/Developer is responsible for performing all appropriate clinical content research.

The Clinical Content Analyst/Developer is responsible for performing all required clinical content updates in all content database tools as necessary.

The Clinical Content Analyst/Developer is responsible for understanding the basic CXT rule function to development and maintain clinical content.

2. The Analyst/Developer is responsible for clearly and concisely articulating any clinical content changes that are recommended by the Analyst/Developer, as needed. These discussions would occur during weekly team meetings or other clinical content meetings where discussion of clinical content would be required.

Job Qualifications:
Training/Business Experience:

  • American Academy of Professional Coders CPC certification or American Health Information Management Association CCS-P certification is required, prior to hire date.
  • Registered Nurse (U.S. or Philippine)
  •  Two years or more relevant healthcare experience as a medical coder, medical biller, medical claims processor, claims reviewer, bill reviewer, denial management or medical chart auditor/abstractor for Centers for Medicare & Medicaid (CMS) or state Medicaid (e.g. California Medicaid, Texas Medicaid, etc.) is required, with at least one year of recent relevant experience. Relevant experience with inpatient facility, outpatient facility and professional claims is a plus.

Specialized Knowledge/Skills:

  • National medical coding certification CPC or CCS-P is required
  • Must possess current, strong working knowledge of CPT codes & guidelines, HCPCS codes & guidelines, current ICD-10-CM codes & guidelines as well as current medical coding and billing guideline expertise and experience, with topics to include but not limited to Medicare Physician Fee Schedule DB, etc.
  • Results driven individual.
  • Ability to be self-directed daily, with high level of integrity and to successfully manage multiple priorities with deliverables completed on time and with high quality.
  • Ability to present confidently in large group settings.
  • Demonstrated proficiency with various software applications, including but not limited to: MS Word; MS Excel; Outlook.
  • Ability to use Access at a beginner level is a plus.
  • Outstanding problem-solving skills; ability to step through logical pathways to confirm expected results.

Company Overview

MicroSourcing is one of the leading offshoring and outsourcing solutions providers in the Philippines. Voted Best Non-voice Excellence Company of the Year in 2014, we are not your average BPO. We cater to foreign companies who operate in a wide variety of industries from all over the world. Therefore, you have the opportunity to do what you love and grow your career.

Our offices are located at Eastwood City, Mall of Asia Complex, Bonifacio Global City, Ortigas Center, and Cebu IT Park, all easily accessible no matter where you live. Join our growing family and be part of an international and collaborative working environment.

Visit and apply at one of our Career Hubs, Monday-Friday, 9AM-5PM with your updated resume and a valid ID:

  • Eastwood Career Hub – 6th Floor, 1880 Building, Eastwood City Cyberpark, Bagumbayan, Quezon City | https://www.microsourcing.com/about-us/locations/#Delivery-Center-1880-Avenue-Building
  • Ortigas Career Hub – 32nd Floor, Cyberscape Beta Building, Topaz Road, Ortigas Center, Pasig City | https://www.microsourcing.com/about-us/locations/#Delivery-Center-Ortigas-Center
  • MOA Complex Career Hub – Ground Floor, TwoE-com Center,  Mall of Asia Complex, Pasay City | https://www.microsourcing.com/about-us/locations/#Delivery-Center-TwoEcom-Center
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