Clinical Review Specialist

1 month ago


Cebu and Pasig, Philippines Gratitude Philippines Full time
Job Title: Clinical Review Specialist

We are seeking a skilled and detail-oriented Clinical Review Specialist to join our team at Gratitude Philippines. Salary: $60,000 - $80,000 per annum, depending on experience.

About the Role:
This is an exciting opportunity for a Registered Nurse with CIC/CCS certification to work as a Clinical Review Specialist. The successful candidate will perform regular audits of clinical practices, patient records, and healthcare processes, analyzing findings and data to identify trends, patterns, and areas of risk.

Key Responsibilities:
* Conduct thorough audits of clinical practices and patient records to ensure compliance with regulatory requirements.
* Analyze audit findings and data to identify areas of risk and develop recommendations for improvement.
* Collaborate with healthcare professionals to implement changes and monitor their effectiveness.
* Develop educational materials and resources to support ongoing staff development.
* Utilize knowledge of healthcare claims payment policy and processing to ensure accurate and efficient clinical reviews.

Requirements:
* Registered Nurse with CIC/CCS certification and prior auditing/DRG experience preferred.
* Strong understanding of US Healthcare regulations, medical coding, medical billing, and RCM health plan operations.
* Excellent written and verbal communication skills, with ability to think logically and process sequentially with high accuracy and efficiency.
* Proficient in Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook.

Benefits:
* Competitive salary range based on experience.
* Opportunities for professional growth and development.
* Collaborative and dynamic work environment.

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