Clinical Program Nurse I

4 weeks ago

Iloilo City, Philippines Crawford Group Full time

Responsible for auditing in-patient and/or surgical bills to promote excellence in medical bill review and process improvement.

Responsibilities
  • Medical Bill Review
    • Processes inpatient and/or surgical bills by adhering to the given standard operating procedures (SOP) and turnaround time to complete the task.
    • Performs bill review process by utilizing appropriate resources.
    • Clarifies billing discrepancies to analyze and recommend appropriate reimbursement.
    • Documents pertinent information in the system bill notes to support reimbursement determination.
    • Performs reconsideration of bills, as per request, to ensure original bill processing determination is appropriate.
    • Collaborates objectively with peer physicians to facilitate determination of reimbursement.
    • Demonstrates knowledge and understanding of Broadspire medical department policies and procedures and ability to communicate same with internal/ external customers as necessary.
  • Business Process Support
    • Provides 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.
    • Communicates effectively with persons involved in case management process as needed.
    • Liaise with company attorneys to assist in possible litigated claims.
    • Refers matters beyond limits of authority and expertise to immediate superior for direction.
    • Upholds the Crawford Code of Conduct by protecting the confidentiality of information.
    • Performs other related tasks as required or needed.
    • Demonstrates 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.
  • 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.
Job Info
  • Job Identification 2682
  • Job Category Support Role
  • Posting Date 08/13/2025, 12:25 PM
  • Job Schedule Full time
  • Job Shift Night
  • Locations 2nd Floor, Three Techno Place, Iloilo, 5000, PH 22nd floor Twenty Four Seven McKinley Building, Manila, 1634, PH (Hybrid)
  • Process Code BSI006.005
  • Equipment Field Dell Wyse 5470 Mobile Thin Client Package with 1 monitor, keyboard, mouse, cables
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