Senior Medical Content Analyst
加入微源！登录奖金：获得一个月的薪水相当的奖励！职位：高级医学内容分析师工作设置和转班：从家工作时，为什么要参加微源？你将得到：·竞争性奖励：享受市场优惠的补偿，第一天医疗保险，加上一个或多个受理人，付费休息，现金转换，团体生命保险和绩效奖金 ·协作精神：通过参与公司主办的活动和活动来促进积极和有吸引力的工作环境。· Work-Life Harmony:享受适合你的灵活的工作安排之间的平衡。·职业发展：利用不断学习和职业进步的机会。· 包容性团队工作：成为庆祝多样性并促进包容文化的一支团队的一部分。你的角色：作为高级医学内容分析师，你将：·临床政策研究：分析医疗保险，医疗补助和商业收费政策以确定拒绝申请标准，覆盖范围限制，年龄/数量门以及服务场所规则。· 索引引引擎规则优化：维护和更新数据库平台内的临床逻辑，管理 ICD-10-CM,CPTS,CPT 和 HCPCS 代码添加，删除和编辑。· 医学演讲主任：准备书面总结和为医疗主管 （医生）和临床利益相关者进行口头演讲，以确保对拟议的拒绝规则达成一致。·复杂编码解决方案：解释复杂的 ICD-10-CM 公约，住院编码指南以及编码修改来解决模糊的业务规则要求。·数据库输入与系统维护：使用 JIRA,SharePoint,MS 客户端访问和 Excel 执行精确的临床内容更新数据输入，政策变化和编码逻辑。·营运支持：向美国健康计划客户和内部产品团队提供临床编码支持和规则解释。你需要什么：不可妥协的 ·教育基金会：护理学士学位 (BSN) ·积极专业编码认证：Active AAPC CPC （认证专业编程师）或 AHIMA CCS-P （认证编码专家医生）. · 4年以上美国卫生保健付款人经验：至少4年的实践体验在医学账单，编码，索赔处理，图表审计或与美国健康保险支付者上诉。·临床编码和政策专业知识：D
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Discover your 100% YOU with MicroSourcing!
Sign-On Bonus: Earn a bonus equivalent to 1 month's salary upon joining!
Position: Senior Medical Content Analyst
Work setup & shift: Work From Home| Night Shift
Why join MicroSourcing?
You'll have:
- Competitive Rewards: Enjoy above-market compensation, healthcare coverage on day one, plus one or more dependents, paid time-off with cash conversion, group life insurance, and performance bonuses
- A Collaborative Spirit: Contribute to a positive and engaging work environment by participating in company-sponsored events and activities.
- Work-Life Harmony: Enjoy the balance between work and life that suits you with flexible work arrangements.
- Career Growth: Take advantage of opportunities for continuous learning and career advancement.
- Inclusive Teamwork: Be part of a team that celebrates diversity and fosters an inclusive culture.
Your Role:
As a Senior Medical Content Analyst, you will:
- Clinical Policy Research: Analyze Medicare, Medicaid, and commercial billing policies to identify claim denial criteria, coverage limitations, age/quantity thresholds, and place-of-service rules.
- Claim Engine Rule Optimization: Maintain and update clinical logic within database platforms, managing code additions, deletions, and edits for ICD-10-CM, CPT, and HCPCS.
- Medical Director Presentations: Prepare written summaries and conduct oral presentations for Medical Directors (physicians) and clinical stakeholders to secure consensus on proposed denial rules.
- Complex Coding Resolution: Interpret complex ICD-10-CM conventions, inpatient coding guidelines, and coding edits to resolve ambiguous business rule requirements.
- Database Entry & System Maintenance: Perform precise data entry of clinical content updates, policy changes, and coding logic using JIRA, SharePoint, MS Access, and Excel.
- Client & Operational Support: Provide clinical coding support and rule explanations to US health plan clients and internal product teams.
What You Need:
Non-negotiables
- Educational Foundation: Bachelor of Science in Nursing (BSN)
- Active Professional Coding Certification: Active AAPC CPC (Certified Professional Coder) or AHIMA CCS-P (Certified Coding Specialist – Physician-based).
- 4+ Years US Healthcare Payer Experience: Minimum 4 years of hands-on experience in medical billing, coding, claims processing, chart auditing, or appeals with US health insurance payers.
- Clinical Coding & Policy Expertise: Deep understanding of ICD-10-CM, CPT, HCPCS, NCCI edits, LCDs/NCDs, and inpatient coding guidelines.
- Technical & Database Proficiency: Demonstrated skill with MS Office (Word, Excel, Access), Visio, JIRA, and database tracking systems.
Preferred skills/expertise
- Prior experience in denial management, utilization review, or claim audit management for US health insurance payers.
- Familiarity with enterprise payment integrity platforms or automated claim editing software.
- Practical knowledge of MS Visio for workflow mapping and MS Project for content tracking.
- Advanced presentation and stakeholder engagement skills for collaborating with physician leadership.
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About MicroSourcing
With over 9,000 professionals across 13 delivery centers, MicroSourcing is the pioneer and largest offshore provider of managed services in the Philippines.
Our commitment to 100% YOU
MicroSourcing firmly believes that our company's strength lies in our people's diversity and talent. We are proud to foster an inclusive culture that embraces individuals of all races, genders, ethnicities, abilities, and backgrounds. We provide space for everyone, embracing different perspectives, and making room for opportunities for each individual to thrive.
At MicroSourcing, equality is not merely a slogan – it's our commitment. Our way of life. Here, we don't just accept your unique authentic self - we celebrate it, valuing every individual's contribution to our collective success and growth. Join us in celebrating YOU and your 100%!
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Originally posted on Himalayas