PRINCIPLE PURPOSE OF JOB:
We are currently seeking Clinical Analyst to support a growing client base while combining their clinical and/or coding expertise with payment accuracy. The Clinical Analyst is responsible for analyzing and interpreting and assign the correct codes for the descriptions available on various medical procedures and diagnosis and other related medical coding as per the medical policy requirements.
Principal Duties/ Responsibilities:
- Perform daily audits on client data for completeness and accuracy of coding utilizing both coding and clinical background to ensure appropriateness for reimbursement
- Respond to provider appeals.
- Respond to client logics and record reviews
- Monitor acceptance rates for assigned clients and assist management in proactively detecting negative deviations.
- Contribute to PCI product by providing feedback to Management/Development Teams on changes to enhance editing and efficiency.
- Reports his/her work performance on a timely basis to the team lead
- Works diligently to meet and exceed productivity and quality benchmarks
- Takes charge of ongoing learning and development and participates in relevant training and development activities
RELEVANT EXPERIENCE & EDUCATIONAL REQUIREMENTS:
- 1 years of experience in medical coding / US healthcare claims processing
- Experience with E&M and Denial Management
- Possesses knowledge of healthcare claims payment policy and processing –
- specifically, CMS, Medicaid regulations, AAOS, ICD-10, CPT & HCPCS, etc.
- Registered Nurse with CPC/COC certification or Bachelor's Degree from Allied Sciences with CPC certification
- Must be willing to work onsite
Office Location:
- Manila: Cotiviti Office located at 15th Floor, Robinsons Cyberscape Gamma, Topaz Rd, Ortigas Center, Pasig
