Clinical Program Nurse I

2 days ago

Manila, National Capital Region, Philippines Crawford & Company Full time $40,000 - $60,000 per year

Job Description
Responsible for auditing in-patient and/or surgical bills to promote excellence in medical bill review and process improvement.

Responsibilities

  • Medical Bill Review

  • Processes inpatient and/or surgical bills by adhering to the given standard operating procedures (SOP) and turnaround time to complete the task.

  • Performs bill review process by utilizing appropriate resources.
  • Clarifies billing discrepancies to analyze and recommend appropriate reimbursement.
  • Documents pertinent information in the system bill notes to support reimbursement determination.
  • Performs reconsideration of bills, as per request, to ensure original bill processing determination is appropriate.
  • Collaborates objectively with peer physicians to facilitate determination of reimbursement.

  • Demonstrates knowledge and understanding of Broadspire medical department policies and procedures and ability to communicate same with internal/ external customers as necessary.

  • Business Process Support

  • Provides assistance to Business Process Associates and other concerned departments with regards to billing issues, inquiries on fee schedules and/or ground rules for a particular state.

  • Inform appropriate process owner regarding issues related to calculation of reimbursement.
  • Communicates effectively with persons involved in case management process as needed.
  • Liaise with company attorneys to assist in possible litigated claims.
  • Refers matters beyond limits of authority and expertise to immediate superior for direction.
  • Upholds the Crawford Code of Conduct by protecting the confidentiality of information.
  • Performs other related tasks as required or needed.
  • Demonstrates knowledge and understanding of Broadspire medical department policies and procedures and ability to communicate same with internal/ external customers as necessary.

Qualifications

  • Bachelor's degree in Nursing.
  • Must have an active and in good standing without restriction Philippine RN license.
  • Minimum of one (1) year diverse clinical experience or prior experience in medical bill review or claim/case review.
  • Good communication skills.
  • Proficient in word processing software applications.
  • Analytical skills - Ability to perform basic bill review according to standard operating procedures (SOP).
  • Maintains high degree of professionalism and confidentiality.
  • Ability to multi-task, prioritize and manage time effectively.
  • Interpersonal skills - Able to work independently and as a team member.
  • Keen attention to details.
  • Must complete continuing education requirements mandated the Professional Regulation Commission.
  • Must complete courses as outlined by Crawford Educational Services.

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