Clinical Validation Specialist

2 days ago

Taguig, National Capital Region, Philippines beBeeValidation Full time ₱216,000 - ₱300,000

Job Title: Clinical Validation Specialist

Job Description:

The Clinical Validation Specialist is responsible for reviewing medical records to validate the accuracy of coding and reimbursement for clinical services rendered to beneficiaries of health plans.

Key Responsibilities:

  • Reviews inpatient medical records to validate assignment and sequencing of ICD-9-CM and ICD-10 diagnosis and procedure codes, discharge status codes, and DRG assignment.
  • Provides a detailed rationale for every medical record review resulting in a DRG Review Results letter, including supporting references.
  • Follows proper procedure for referral to Clinical Nurse Auditor or Physician Advisor, as applicable.
  • Utilizes proper reference material, standards, and guidelines for coding.
  • Provides input to the Edit Development team on claims selection criteria.
  • Verifies data received from client and works to resolve discrepancies.
  • Interacts with Providers and other personnel in a professional manner, if onsite review is required.
  • Follows company policies and processes, completing required documents in a timely manner.
  • Communicates timely with Team Lead regarding illnesses, appointments, vacation requests, changes in work schedule, performance barriers, and computer issues.
  • Complies with department standards regarding productivity and audit quality.
  • Performs other duties as assigned.
Required Skills and Qualifications:

To be successful in this role, you must possess the following skills and qualifications:

  • Possesses current AHIMA credentials (RHIT/RHIA/CCS), with current CCS preferred.
  • Demonstrates extensive knowledge of ICD-9-CM and ICD-10 coding and DRG reimbursement, with a minimum of five years of inpatient coding experience.
  • Previous experience training and mentoring junior-level coders is highly desired.
  • Must understand government and commercial provider reimbursement methodologies, and possesses strong data analytic skills.
  • Ability to write a well-reasoned review in a narrative style, with accurate spelling, grammar, punctuation, and sentence structure.
  • Must be able to adapt to changing priorities in order to meet client requirements, and is required to meet department productivity standards and deadlines.
  • Amenable to work in shifting schedule.
  • Temporary WFH available.
Benefits:

As a valued member of our team, you will enjoy the following benefits:

  • Opportunity to work with a dynamic team in a fast-paced environment.
  • Professional growth and development opportunities.
  • Competitive compensation package.
  • Flexible work arrangements, including remote work options.
Others:

While we strive to provide a comprehensive job description, please note that this list of responsibilities may not be exhaustive. We may revise the job description at any time, as necessary, to reflect the evolving needs of the organization.

At our company, we recognize the importance of diversity and inclusion in the workplace. We are an equal opportunity employer and welcome applications from candidates of all backgrounds.

  • PHRN Clinical Data Validation

    2 days ago

    Taguig, National Capital Region, Philippines Tata Consultancy Services Full time $40,000 - $80,000 per year

    Job SummaryWe are seeking a Registered Nurse (RN) based in the Philippines to join our healthcare IT team. This role focuses on clinical data validation during an electronic health record (EHR) migration. You will review, compare, and validate patient data (e.g., medications, allergies, diagnoses, lab results, and clinical notes) from the source system...

  • PHRN Clinical Authorization Specialist-BLENDED

    2 days ago

    Taguig, National Capital Region, Philippines Nezda Technologies, Inc. Full time ₱40,000 - ₱53,000 per year

    We Are Hiring: Clinical Authorization Specialists (Surgery, Pharmacy, Oncology) - BLENDED ACCOUNT Taguig | Night Shift | Onsite | Up to 53K Package | Start ASAP - September 22Open Roles:Clinical Authorization SpecialistClinical Authorization Specialist (Pharmacy)Clinical Authorization (Surgery & Oncology)QA – Clinical Authorization (Surgery &...

  • DRG Validation Auditor

    2 days ago

    Taguig, National Capital Region, Philippines Enigma Farms Ltd Full time ₱60,000 - ₱70,000 per year

    Job Title: MSDRG NurseLocation: Taguig CityWork set up: HybridSalary: PHP 60,000 - PHP 70,000Work schedule: Night shiftPosition DescriptionThe DRG Validation Auditor is part of the DRG Validation Team and is responsible for reviewing medical records to ensure accurate coding and proper reimbursement for clinical services provided to members of Commercial and...

  • Clinical Healthcare Specialist

    4 days ago

    Taguig, National Capital Region, Philippines beBeeData Full time ₱800,000 - ₱1,200,000

    Medical Data Analyst Job DescriptionWe are seeking a highly skilled and detail-oriented Medical Data Analyst to join our team. This role focuses on clinical data validation during an electronic health record migration.Key Responsibilities:Data Validation & Review:Review patient records (medications, allergies, diagnoses, procedures, labs, immunizations,...

  • Remote Data Validation Specialist

    2 days ago

    Taguig, National Capital Region, Philippines Eastvantage Full time $40,000 - $80,000 per year

    We're Hiring: Remote Data Validation Specialist (ZoomInfo & HubSpot Pro) About The RoleWe are seeking a detail-oriented and highly organizedData Validation Specialistto ensure the accuracy and integrity of our contact database. This role requires a keen eye for detail, strong data analysis skills, and the ability to work independently to identify and...

  • Clinical Authorization Process Specialist

    7 days ago

    Taguig, National Capital Region, Philippines beBeeAuthorization Full time ₱1,200,000 - ₱2,000,000

    Healthcare Authorization SpecialistQuality Auditor hiring Clinical Authorization Process.Must hold an active PHRN license (not a USRN license holder)Relevant experience as a Quality Auditor in Clinical Services within a healthcare environment; alternatively, 4 to 7 years of specialized experience in Clinical Authorization or Utilization Review is...

  • Clinical Appeals Nurse

    2 days ago

    Taguig, National Capital Region, Philippines KMC Solutions Full time $60,000 - $80,000 per year

    Make your next big career move by applying as KMC Solutions' next PHRN – CLINICAL DENIALS AND APPEALS The PHRN - Clinical Denials and Appeals is responsible for reviewing and addressing medical necessity and authorization-related claim denials by conducting thorough clinical reviews, preparing appeal letters, and communicating effectively with payers. This...

  • Remote Data Validation Specialist

    2 days ago

    Taguig, National Capital Region, Philippines Eastvantage Business Solutions Inc. Full time $60,000 - $80,000 per year

    About the Role:We are seeking a detail-oriented and highly organized Data Validation Specialist to ensure the accuracy and integrity of our contact database. This role requires a keen eye for detail, strong data analysis skills, and the ability to work independently to identify and resolve data discrepancies. You will play a critical role in maintaining the...

  • Remote Data Validation Specialist

    3 weeks ago

    Taguig, National Capital Region, Philippines Eastvantage Full time

    We're Hiring: Remote Data Validation Specialist (ZoomInfo & HubSpot Pro) About the Role:We are seeking a detail-oriented and highly organizedData Validation Specialistto ensure the accuracy and integrity of our contact database. This role requires a keen eye for detail, strong data analysis skills, and the ability to work independently to identify and...

  • clinic administrative associate

    2 days ago

    Taguig, National Capital Region, Philippines The Medical City Full time ₱104,000 - ₱130,878 per year

    The Medical City Clinic (Market Market) is searching for a Clinic Administrative Associate to join the team and help lead the organization to the next level. This role serves as the initial contact point for patients thus ensuring proper service architecture is given by assisting them with general inquiries, validating information for medical care access,...