
USRN Nurse Trainer
2 weeks ago
Work Setup/Shift: WFO / Night shift
Start Date: ASAP
Qualifications:
- Nursing Graduate (Bachelor's Degree)
- Active USRN License of any state (but NY is preferred)
- At least 1-2 years as a Process Trainer
- Minimum 1-2 years of US Healthcare account experience (Utilization Management Review and Clinical Appeals)
- Experience with utilization of Interqual/MCG Guidelines
- Exposure to Inpatient/Concurrent reviews
- Must be amenable to report in Manila
Responsibilities:
1. Clinical Review & Auditing:
- Review patient medical records to ensure the accuracy and completeness of documentation.
- Evaluate and verify the appropriateness of medical codes based on patient diagnoses and procedures.
- Assist in medical coding audits and provide recommendations for improvements.
- Collaborate with other healthcare professionals to resolve discrepancies in patient records.
2. Medical Coding Support:
- Work closely with medical coders to ensure compliance with U.S. healthcare regulations and standards.
- Provide clinical expertise in the identification of proper coding for procedures and diagnoses.
- Maintain knowledge of the latest updates to ICD-10, CPT, and other coding guidelines.
3. Quality Assurance & Compliance:
- Ensure that all healthcare documentation aligns with U.S. healthcare laws, policies, and regulations (HIPAA, CMS).
- Identify trends or recurring issues related to clinical documentation and coding, and escalate as necessary.
- Participate in training programs to stay updated on U.S. healthcare regulations and clinical practices.
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