![Visaya KPO](https://media.trabajo.org/img/noimg.jpg)
Clinical Nurse Auditor
4 weeks ago
This position performs audits of medical records on behalf of hospital clients for denial review, disallowed charges, and utilization reviews. This position requires critical thinking and judgment and must demonstrate the ability to appropriately use standard criteria such as InterQual and MCG in addition to criteria established by state Medicaid programs or hospital contract or policy. Audit and analysis must be accurate and consistently ensure a high level of quality, knowledge of state and federal laws, rules, regulations and guidelines necessary to ensure compliance and protection of information.
Essential Duties and Responsibilities
Defends audits of outpatient medical records to identify and/or defend charges, including: Patient Inquiry Audit, Charge Hold Audits, Biller Requested Audits
Completes analysis of records for outpatient reviews such as: Denied line items, Experimental denials.
Reviews medical records against established criteria (MCG, InterQual, Medicare and Medicaid) to determine if patient condition and/or care meets criteria
Determine, request, and obtain appropriate supporting documentation from hospital, physicians, current medical literature and/or patient
Composes appeal letters addressing and appealing both contract issues and medically related issues
Become familiar with assigned facilities CDM and departmental charge protocol
Organizes and prioritizes multiple cases concurrently to ensure departmental workflow and timely case resolution
Identifies trends for clients for denial prevention opportunities
Enter findings and other supporting documentation into Savista’s computer based system.
Proficiently utilize multiple computer based systems to complete and document work
Function in a professional, efficient and positive manner
Must be customer-service focused and exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession
Maintain confidentiality of patient information and abide by all HIPAA related guidelines
Minimum Requirements & Competencies:
LPN
3 to 5 years of hospital/clinical experience
Knowledge of MCG and/or InterQual criteria
Experience in medical records review, claims processing or utilization/case management in a hospital, clinical practice or managed care organization
Fundamental knowledge of Medicare/Medicaid Guidelines
Proficiency in navigating the internet and multi-tasking with multiple electronic documentation systems simultaneously (toggling)
Demonstrated ability to navigate Internet Explorer and Microsoft Office, including the ability to input and sort data in Microsoft Excel and use company email and calendar tools.
Demonstrated success working both individually and in a team environment.
Demonstrated experience communicating effectively with payers, understanding complex information and accurately documenting the encounter.
Ability to work effectively with cross-functional teams to achieve goals.
Demonstrated ability to meet performance objectives.
Preferred Requirements & Competencies:
Experience with Epic, Meditech, Cerner, Invision, Paragon, Soarian, Collections Management or STAR.
Experience working with or for a hospital/hospital system with more than 250 beds.
Experience with both hospital (facility) and physician (pro-fee) A/R.
Job Type: Full-time
Schedule:
8 hour shift
-
Clinic Nurse
2 weeks ago
Manila, National Capital Region, Philippines Cobden & Carter International Full timeWe are hiring Clinic NursesRoles and Responsibilities of Clinic Nurse:Provide quality care and assistance to patients and doctors in the clinics.Provides assistance and out-patient service to patients/ members.Administers basic medical services (e.g. nebulization, render emergency first aid, administration of r oral/injectable as per advice of physicians on...
-
Senior Quality Manager, GxP Auditor
2 weeks ago
Manila, National Capital Region, Philippines George Clinical Full timeSenior Quality Manager, GxP Auditor - open to all Asian locationsHR Manager, East Asia at George ClinicalAn opportunity has arisen for an experienced, adaptable and committed Senior Quality Manager/ GxP Auditor to join our dynamic team in any of the following locations - Hong Kong, Malaysia, Taiwan, Philippines or Singapore.We have many new ground-breaking...
-
Clinical Appeals Nurse
4 days ago
Manila, National Capital Region, Philippines SALES RAIN BPO, INC. Full timeJoin our dedicated team at HBiz where we strive to provide outstanding care and service excellence. We are currently seeking a highly skilled Clinical Appeals Nurse to play a crucial role in managing medical denials by providing clinical expertise in the appeals process. This position is ideal for those who excel in analytical thinking and have a strong...
-
Clinical Appeals Nurse
4 days ago
Metro Manila, Philippines SALES RAIN BPO, INC. Full timeJoin our dedicated team at HBiz where we strive to provide outstanding care and service excellence. We are currently seeking a highly skilled Clinical Appeals Nurse to play a crucial role in managing medical denials by providing clinical expertise in the appeals process. This position is ideal for those who excel in analytical thinking and have a strong...
-
Clinical Nurse Auditor
3 months ago
Manila, Philippines Visaya KPO Full timeJob Summary: This position performs audits of medical records on behalf of hospital clients for denial review, disallowed charges, and utilization reviews. This position requires critical thinking and judgment and must demonstrate the ability to appropriately use standard criteria such as InterQual and MCG in addition to criteria established by state...
-
Clinical Nurse Auditor
4 weeks ago
Manila, Philippines Visaya KPO Full timeJob Summary: This position performs audits of medical records on behalf of hospital clients for denial review, disallowed charges, and utilization reviews. This position requires critical thinking and judgment and must demonstrate the ability to appropriately use standard criteria such as InterQual and MCG in addition to criteria established by state...
-
QA Auditor for Home Health
2 weeks ago
Metro Manila, Philippines Virtual Medical Staffing Full timeCompany Overview:We are a company built on trust and loyalty. MBVA 24/7 started in 2018 and has continuously fostered skilled and talented Virtual Assistants for many clients. Our team of virtual assistants provides services all over the US, and we sure won’t be stopping there! Our main office is located in Arizona and Manila. We have a legion of virtual...
-
Registered Nurse for our Doctors Clinic
20 hours ago
Manila, Philippines ACTFA Medical & Laboratory Diagnostics Full timeWe are looking for a Registered Nurse to assist at our Doctors' Clinics during patient consultationThe ideal candidate will be a responsible and well-trained professional able to give the best nursing care with little supervision. You will be compassionate and cool-tempered. You will also be able to follow health and safety guidelines faithfully and...
-
Registered Nurse for our Doctors Clinic
9 hours ago
Manila, Philippines ACTFA Medical & Laboratory Diagnostics Full timeWe are looking for a Registered Nurse to assist at our Doctors' Clinics during patient consultation The ideal candidate will be a responsible and well-trained professional able to give the best nursing care with little supervision. You will be compassionate and cool-tempered. You will also be able to follow health and safety guidelines faithfully and...
-
QA Auditor for Home Health
2 weeks ago
Manila, National Capital Region, Philippines Virtual Medical Staffing Full timeCompany Overview:We are a company built on trust and loyalty. MBVA 24/7 started in 2018 and has continuously fostered skilled and talented Virtual Assistants for many clients. Our team of virtual assistants provides services all over the US, and we sure won't be stopping there Our main office is located in Arizona and Manila. We have a legion of virtual...
-
QA Auditor for Home Health
2 weeks ago
Manila, National Capital Region, Philippines Virtual Medical Staffing Full timeCompany Overview:We are a company built on trust and loyalty. MBVA 24/7 started in 2018 and has continuously fostered skilled and talented Virtual Assistants for many clients. Our team of virtual assistants provides services all over the US, and we sure won't be stopping there Our main office is located in Arizona and Manila. We have a legion of virtual...
-
Registered Nurse for our Doctors Clinic
8 hours ago
Manila, Philippines ACTFA Medical & Laboratory Diagnostics Full timeWe are looking for a Registered Nurse to assist at our Doctors' Clinics during patient consultation The ideal candidate will be a responsible and well-trained professional able to give the best nursing care with little supervision. You will be compassionate and cool-tempered. You will also be able to follow health and safety guidelines faithfully and...
-
Staff Nurse
2 weeks ago
Manila, National Capital Region, Philippines RadLink Philippines Corporation Full timePurpose of Position: The Staff Nurse is primarily responsible for the efficient operation and proper maintenance of the center's Nursing and Diagnostic department. They provide quality nursing care to all clients. The Staff Nurse works closely with the Clinic Manager and Senior Nurse Manager in ensuring both operational and Clinical standards are...
-
Staff Nurse
2 weeks ago
Manila, National Capital Region, Philippines RadLink Philippines Corporation Full timePurpose of Position: The Staff Nurse is primarily responsible for the efficient operation and proper maintenance of the center's Nursing and Diagnostic department. They provide quality nursing care to all clients. The Staff Nurse works closely with the Clinic Manager and Senior Nurse Manager in ensuring both operational and Clinical standards are...
-
Registered Nurse
1 month ago
Manila, Philippines VMV Hypoallergenics Full timeThe CLINICAL NURSE will work closely with some of the top dermatologists in the country, assisting them in clinical trials, treatment, and care of patients in advanced procedural dermatology, research, and more.This position will handle Patient Management and Clinical MD Support:1. Assist in performing skin exams for skin cancer and other conditions.2....
-
Registered Nurse
4 weeks ago
Manila, Philippines VMV Hypoallergenics Full timeThe CLINICAL NURSE will work closely with some of the top dermatologists in the country, assisting them in clinical trials, treatment, and care of patients in advanced procedural dermatology, research, and more.This position will handle Patient Management and Clinical MD Support:1. Assist in performing skin exams for skin cancer and other conditions.2....
-
Registered Nurse
2 weeks ago
Manila, National Capital Region, Philippines VMV Hypoallergenics Full timeThe CLINICAL NURSE will work closely with some of the top dermatologists in the country, assisting them in clinical trials, treatment, and care of patients in advanced procedural dermatology, research, and more.This position will handle Patient Management and Clinical MD Support:1. Assist in performing skin exams for skin cancer and other conditions.2....
-
Clinic Nurse
1 day ago
Manila, National Capital Region, Philippines Cardinal Santos Medical Center Full timeJOB SUMMARYResponsible in maintaining and/or improving the health status of employees.Promote optimum health status and lifestyles for all employees through the joint efforts of the management and the Wellness Center. Promote patient safety and support all related programs and policies to ensure delivery of excellent patient care. QUALIFICATIONSCompletion of...
-
Staff Nurse
2 weeks ago
Metro Manila, Philippines RadLink Philippines Corporation Full timePurpose of Position: The Staff Nurse is primarily responsible for the efficient operation and proper maintenance of the center’s Nursing and Diagnostic department. They provide quality nursing care to all clients. The Staff Nurse works closely with the Clinic Manager and Senior Nurse Manager in ensuring both operational and Clinical standards are...
-
Clinic Nurse
2 weeks ago
Manila, National Capital Region, Philippines GHS Inc. Full timeQualifications:- Has Active PRC License- No clinical experience is necessary- 20k Signing Bonus- 1-Day Regularization- Day 1 HMO and Life InsuranceToxic Environment