Medical Content Analyst (Healthcare)

Location: Manila, Philippines

Company

hirify.global provides healthcare decision intelligence software that uses responsible AI and clinical, payment, regulatory, and policy expertise to support transparent, auditable claims decisions.

What you will do

• Update diagnosis codes, procedure codes, age limits, quantity limits, place-of-service limits, and other clinical content criteria.
• Present proposed denial criteria to Medical Directors and clinical colleagues to reach consensus.
• Provide clinical content support to customers.
• Enter clinical content updates into the database.
• Interpret inpatient coding and ICD-10-CM conventions for inclusion or exclusion in business rules.
• Recommend denial criteria for diagnoses, age, and other medical claim attributes.

Requirements

• BS in Nursing or an equivalent qualification.
• At least 4 years of experience in medical billing, coding, claims processing, bill or chart review, or auditing.
• Previous experience with US health insurance payers in claims, appeals, or coding.
• Excellent written and verbal communication skills.
• Proficiency with MS Word, MS Excel, MS Access, Visio, JIRA, and SharePoint.
• AHIMA CCS-P or AAPC CPC certification required.

Nice to have

• Experience in denial management or claim review management.
• Experience with MS Project.

Culture & Benefits

• Work on healthcare decision intelligence supporting real-time claims workflows.
• Contribute to a platform used by major US health plans.
• Collaborate with physicians, clinical colleagues, customers, and internal business teams.