medical content specialist 3 ( Pharmacy) backfillThe VITO Consulting Group

Qualifications:
Bachelor of Pharmacy degree from accredited University i.e.
Registered Pharmacist or United States equivalent is required;
Master's degree preferred. ·
American Academy of Professional Coders CPC certification is required.
Five 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.
Creation, revision, and deletion of clinical content (procedure codes, diagnosis codes, modifiers) based upon 3rd party source file and/or guideline information.
Updating other claim's billing criteria i.e.,
Age or Maximum units allowed based on drug administration for each indication for a given pharmaceutical agent.
Assigning and mapping all valid ICD-10 CM codes billable for each On-Label as well as Off-Label indication for a given pharmaceutical agent.
Maintaining the Clinical Manuals of Specialty Drugs through research using drug literature and Compendia's.
Ability to follow Specialty Pharmacy project development philosophy and codes drugs policy accordingly.
Work closely with Medical Director in developing medical policies for Specialty Pharmaceutical agents based on recommended sources.
Performing analysis of specialty drugs and drug content information included in Local Coverage Determinations (as needed)
Attending and providing content presentations during team meetings as needed
The content updates are identified by reviewing clinical sources such as but not limited to the following entities:
Medicare Claims Processing manual, CMS transmittals, AMA publications, CPT changes and new code updates, HCPCS code updates, National Comprehensive Cancer Network Compendium/guidelines, Clinical Pharmacology (CP), Federal Drug Administration, NCCI (National Correct Coding Initiative) policy manuals, Medicaid Policy Edit & Design Manuals, ICD-10-CM diagnosis ICD-10-PCS procedure code updates, National Coverage Determinations (NCD's), Local Coverage Determinations (LCD's), State Medicaid manuals, bulletins, banners publications, Drug compendium and Other 3rd party and published study i.e., medical literatures.
Strong working knowledge of HCPCS codes & guidelines, current ICD-10-CM codes, and guidelines as well as current medical coding and billing guideline expertise strongly preferred · HIPAA compliance. ·
Efficient in MS software including Excel, Word and PowerPoint. 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.
Schedule:
Night Shift/Temporary WFH
The VITO Consulting Group

Taguig City, Metro Manila
₱50,000-70,000 per month
Permanent
Full-time