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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.
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%!