Medical Content Analyst (Healthcare)

TL;DR

Medical Content Analyst (Healthcare): Researching and identifying Medicare, Medicaid, and medical coding criteria for an automated claims editing solution with an accent on clinical content accuracy and regulatory compliance. Focus on interpreting complex ICD-10-CM coding conventions and presenting denial criteria to medical directors to ensure efficient claims processing.

Location: Manila, Philippines (Onsite)

Company

hirify.global is an AI-first healthcare technology company dedicated to simplifying the business of care by preventing inaccurate payments and reducing waste in the healthcare ecosystem.

What you will do

• Present proposed denial criteria to Medical Directors and clinical colleagues to reach consensus.
• Provide clinical content support to customers as required.
• Perform data entry of clinical content updates into the internal database.
• Interpret inpatient coding and ICD-10-CM conventions for inclusion in business rules.
• Recommend denial criteria for diagnosis, age, and other claim parameters based on coding guidelines.

Requirements

• BS Nursing or equivalent degree required.
• 4 years of experience in medical billing, coding, claims processing, or chart auditing.
• Previous experience working with US health insurance payers in a claims or coding capacity.
• AHIMA Certified Coding Specialist (CCS-P) or AAPC Certified Professional Coder (CPC) certification required.
• Proficiency in MS Office suite, Visio, JIRA, and SharePoint.

Nice to have

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

Culture & Benefits

• Work with a market-leading healthcare technology platform.
• Opportunity to shape the future of healthcare through AI-driven innovation.
• Collaborative environment working with clinical and technical teams.