USRN Trainer

Work Setup/Shift: WFO / Night shift

Start Date: ASAP

Qualifications:

• Bachelor's Degree in Nursing (BSN)
• Active USRN License of any state (NY preferred)
• Atleast 1-2 years as a Process Trainer
• Minimum 1-2 years experience in a US Healthcare account (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.