Clinical Program Nurse I

3 weeks ago

Manila, Philippines Crawford & Company Full time

Job Description Responsible for auditing in-patient and/or surgical bills to promote excellence in medical bill review and process improvement. Responsibilities Medical Bill ReviewProcess inpatient and/or surgical bills by adhering to the given standard operating procedures (SOP) and turnaround time to complete the task. Perform bill review process by utilizing appropriate resources. Clarify billing discrepancies to analyze and recommend appropriate reimbursement. Document pertinent information in the system bill notes to support reimbursement determination. Perform reconsideration of bills, as per request, to ensure original bill processing determination is appropriate. Collaborate objectively with peer physicians to facilitate determination of reimbursement. Demonstrate knowledge and understanding of Broadspire medical department policies and procedures and ability to communicate same with internal/ external customers as necessary. Business Process SupportProvide assistance to Business Process Associates and other concerned departments with regards to billing issues, inquiries on fee schedules and/or ground rules for a particular state. Inform appropriate process owner regarding issues related to calculation of reimbursement. Communicate effectively with persons involved in case management process as needed. Liaise with company attorneys to assist in possible litigated claims. Refer matters beyond limits of authority and expertise to immediate superior for direction. Uphold the Crawford Code of Conduct by protecting the confidentiality of information. Perform other related tasks as required or needed. Demonstrate knowledge and understanding of Broadspire medical department policies and procedures and ability to communicate same with internal/ external customers as necessary. Qualifications Bachelor's degree in Nursing. Must have an active and in good standing without restriction Philippine RN license. Minimum of one (1) year diverse clinical experience or prior experience in medical bill review or claim/case review. Good communication skills. Proficient in word processing software applications. Analytical skills - Ability to perform basic bill review according to standard operating procedures (SOP). Maintains high degree of professionalism and confidentiality. Ability to multi-task, prioritize and manage time effectively. Interpersonal skills - Able to work independently and as a team member. Keen attention to details. Must complete continuing education requirements mandated the Professional Regulation Commission. Must complete courses as outlined by Crawford Educational Services. #J-18808-Ljbffr

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