Job ID: 9772

  • Sep 22, 2020
  • Picadilly Star - Bonifacio Global City

The Clinical Content Analyst/Developer researches, analyzes and creates clinical content for the business rules for Change Healthcare’s Clinical Claims Management (CCM). The CCM Product Line is a fast-paced environment with contractually driven quarterly deliverables. The CCM products are utilized by payer organizations to augment claims management systems, by electronically auditing medical claims, for accurate processing of both professional and facility claims.

The role of the Analyst/Developer is to provide comprehensive and in-depth research, analysis and clinical content development of new and revised clinical content to be offered in existing or new business rules, to expand the CCM suite of offerings.

The content updates are identified by reviewing clinical sources such as but not limited to the Medicare Claims Processing manual, CMS transmittals, AMA publications, CPT changes and new code updates, HCPCS code updates, NCCI policy manuals, Medicaid Policy Edit & Design Manuals, ICD-10-CM diagnosis and ICD-10-PCS procedure code updates, National Coverage Determinations (NCD’s), Local Coverage Determinations (LCD’s), State Medicaid manuals, bulletins, banners publications and other 3rd clinical content sources.

Clinical content includes but is not limited to CPT codes, ICD-10-CM diagnosis codes, HCPCS codes, POS codes, DRG’s, APC’s and other code sets and the translation of written clinical information into auditable clinical content. 

Content development is defined as the identification of a clinical term, surgical procedure or medical condition and translating it into a procedure code, diagnosis code or any other code set element as appropriate.

In addition, the Analyst/Developer is responsible for clearly and concisely articulating any clinical content changes that are recommended by the Analyst/Developer, as needed. This discussion would occur during weekly team meetings or other clinical content meetings where discussion of clinical content would be required. Research, analyze and review clinical content data sources to create update, add or delete clinical content (clinical content meaning CPT, HCPCS, ICD-10-CM, ICD-10-PCS, & all other code sets) opportunities. The Analyst/Developer is responsible for the creation and development of the clinical content to support new and existing CXT business rules.

Clinical Content sources includes but is not limited to:

  • Medicare Claims Processing manual
  • CMS transmittals
  • AMA publications
  • CPT changes and new code updates
  • HCPCS code updates
  • NCCI policy manuals
  • Medicaid Policy Edit & Design manuals
  • ICD-10-CM diagnosis code updates
  • ICD-10-PCS procedure code updates
  • National Coverage Determinations (NCDs)
  •  Local Coverage Determinations (LCDs)
  • State Medicaid manuals, bulletins, banners & publications
  • Other 3rd party clinical content sources

The Clinical Content Analyst/Developer is responsible for reviewing all clinical content sourcing documentation for added content, revised content or deleted clinical content. The Clinical Content Analyst/Developer is responsible for performing all appropriate clinical content research. The Clinical Content Analyst/Developer is responsible for performing all required clinical content updates in all content database tools as necessary. The Clinical Content Analyst/Developer is responsible for understanding the basic CXT rule function to development and maintain clinical content. The Analyst/Developer is responsible for clearly and concisely articulating any clinical content changes that are recommended by the Analyst/Developer, as needed. These discussions would occur during weekly team meetings or other clinical content meetings where discussion of clinical content would be required.

Minimum Qualifications:

  • American Academy of Professional Coders CPC certification or American Health Information Management Association CCS-P certification is required, prior to hire date.      
  • Registered Nurse (U.S. or Philippine)
  • Two years or more relevant healthcare experience as a medical coder, medical biller, medical claims processor, claims reviewer, bill reviewer or medical chart auditor/abstractor is required
  • With at least 1 year of recent relevant experience. Relevant experience with inpatient facility, outpatient facility and professional claims is a plus.

Specialized Knowledge/Skills:

  • National medical coding certification CPC or CCS-P is required
  • Must possess current, strong working knowledge of CPT codes & guidelines, HCPCS codes & guidelines, current ICD-10-CM codes & guidelines as well as current medical coding and billing guideline expertise and experience, with topics to include but not limited to Medicare Physician Fee Schedule DB, etc.
  • Results driven individual.
  • Ability to be self-directed daily, with high level of integrity and to successfully manage multiple priorities with deliverables completed on time and with high quality.
  • Ability to present confidently in large group settings.
  • Demonstrated proficiency with various software applications, including but not limited to: MS Word; MS Excel; Outlook.
  • Ability to use Access at a beginner level is a plus.
  • Outstanding problem-solving skills; ability to step through logical pathways to confirm expected results. 

MicroSourcing offers diversity in career options. We welcome individuality in self-expression without losing the value for team involvement. We are a fresh look at the BPO & KPO industry. Come experience the MicroSourcing life and be part of our growing family.

Cultures and Values

We are a fast growing company but we have always been able to keep the fun, young and intimate atmosphere from the time we started. We strongly believe in transparency and honesty and we always make sure to represent the interests of our employees as much as we represent the interests of our clients.