Clinical Operations Specialist

3 weeks ago


Cebu and Pasig, Philippines Solid Lyndelle Manpower Services Inc. Full time

Solid Lyndelle Manpower Services Inc. seeks a skilled Clinical Auditor to join our team. Below are the key responsibilities and requirements for this role.

Key Responsibilities:

  • Perform regular audits of clinical practices, patient records, and healthcare processes.
  • Analyze audit findings and data to identify trends, patterns, and areas of risk.
  • Monitor the effectiveness of implemented changes and provide ongoing support.
  • Ensure that the organization complies with all relevant regulatory requirements.
  • Develop educational materials and resources to support ongoing staff development.

Requirements:

  • Registered Nurse with CIC/CCS certification and prior auditing/DRG experience preferred.
  • Experience in US Healthcare, medical coding, medical billing, RCM health plan operations strongly preferred.
  • Possesses knowledge of healthcare claims payment policy and processing – specifically CMS, Medicaid regulations, ICD-10 CM & DRG Expert, etc.
  • Practical clinical experience working in a hospital/office or nursing home.
  • Possesses excellent written and verbal communication skills. Ability to think logically and process sequentially with a high level of detailed accuracy and efficiency.
  • Has excellent personal computer skills in Microsoft Word, Excel, PowerPoint, Outlook, etc.

Working Conditions:

  • This position will be working with a solutions and analytics company.
  • Working Set-up: Onsite
  • Mondays to Fridays.
  • Complete details will be provided by our Recruiters.


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