Senior Medical Content Analyst

Location: Manila, Philippines

Company

Healthcare decision intelligence platform combining responsible AI with clinical, payment, regulatory, and policy expertise for real-time claims workflows.

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 and enter approved updates into the database.
• Interpret inpatient coding and ICD-10-CM conventions for inclusion or exclusion in business rules.
• Recommend denial criteria for diagnosis, age, and other medical-claim conditions within the software.

Requirements

• BS in Nursing, BS in Pharmacy, or equivalent.
• At least 5 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.
• AHIMA Certified Coding Specialist–Physician (CCS-P) or AAPC Certified Professional Coder (CPC) certification.
• Strong written and verbal communication skills and proficiency with software such as MS Word, MS Excel, MS Access, Visio, JIRA, and SharePoint.

Nice to have

• Experience in denial management or claims review management.
• Master’s degree in business or a healthcare-related field.
• ClaimsXten experience.
• Experience using AI tools professionally or working at CMS or a health insurance plan.
• Strong analytical and critical-thinking skills, with the ability to communicate complex technical information across written, verbal, and visual formats.

Culture & Benefits

• Collaborative, agile, and fast-paced working environment.
• Opportunity to participate in targeted AI training programs.
• Independent work with minimal supervision and proactive ownership of responsibilities.