Clinical Program Nurse I

24 hours ago

Iloilo City, Western Visayas, Philippines Crawford and Company Full time $40,000 - $60,000 per year

Job DescriptionResponsible for auditing in-patient and/or surgical bills to promote excellence in medical bill review and process improvement. ResponsibilitiesMedical Bill ReviewProcesses 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 SupportProvides 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.

QualificationsBachelor'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 by the Professional Regulation Commission. Must complete courses as outlined by Crawford Educational Services.

  • Clinical Healthcare Specialist

    3 days ago

    Iloilo City, Western Visayas, Philippines beBeeOccupational Full time ₱150,000 - ₱250,000

    Job Title:Nurse / Occupational Health Specialist Job Description:As a Nurse / Occupational Health Specialist, you will provide on-site expertise on direct care for both occupational and non-occupational cases.Provide guidance on health screening results and recommend appropriate intervention.Assist Company Doctor during check-ups and consultation.Maintain an...

  • Project Nurse

    1 day ago

    Iloilo City, Western Visayas, Philippines R-II Builders Inc. Full time ₱600,000 - ₱800,000 per year

    provides on-site primary healthcare, first aid, and emergency response for workers, focusing on occupational health and compliance with safety standards. Responsibilities include managing injuries, monitoring employee health, maintaining medical records, ensuring site health programs are followed, and supporting the EHS team by reporting incidents. The role...

  • Registered Nurse – Seeking NCLEX Sponsorship – Relocation to U.S

    4 days ago

    Iloilo City, Western Visayas, Philippines Conexus MedStaff Full time

    Are you a registered nurse seeking a rewarding career in the U.S.? Do you have current bedside experience at a secondary or tertiary hospital? Conexus MedStaff is ready to sponsor your NCLEX license and offer you a rewarding career in the United States.Conexus offers a comprehensive NCLEX Sponsorship Program for registered nurses. We pay all expenses related...

  • Registered Nurse – Seeking NCLEX Sponsorship – Relocation to U.S

    1 day ago

    Iloilo City, Western Visayas, Philippines Conexus MedStaff Full time $100,000 - $120,000 per year

    Are you a registered nurse seeking a rewarding career in the U.S.? Do you have current bedside experience at a secondary or tertiary hospital? Conexus MedStaff is ready to sponsor your NCLEX license and offer you a rewarding career in the United States.Conexus offers a comprehensive NCLEX Sponsorship Program for registered nurses. We pay all expenses related...

  • Clinical Appeals Nurse

    1 day ago

    Cebu City, Central Visayas, Philippines Health Business Solutions Full time ₱720,000 - ₱1,080,000 per year

    Join our dedicated team at HBiz where we strive to provide outstanding care and service excellence. We are currently seeking a highly skilled Clinical Appeals Nurse to play a crucial role in managing medical denials by providing clinical expertise in the appeals process. This position is ideal for those who excel in analytical thinking and have a strong...

  • Clinical Nurse

    24 hours ago

    Cebu City, Central Visayas, Philippines J. Plazo Staffing Corp Full time ₱360,000 per year

    J. Plazo Staffing Corp is hiring a Full time Clinical Nurse role in Cebu City, Central Visayas. Apply now to be part of our team.Job summary:Flexible hours available1 year of relevant work experience required for this roleExpected salary: ₱30,000 per monthQualifications:Candidate must possess at least Professional License (Passed Board/Bar/Professional...

  • Registered Nurse and Enrolled Nurse

    3 hours ago

    Ormoc City, Eastern Visayas, Philippines Nurse Next Door Home Care Services Full time

    OverviewAt Nurse Next Door, nurses are at the heart of everything we do. If you are a kind, caring and compassionate individual who is passionate about Making Lives Better… Nurse Next Door has the perfect opportunity for you We're seeking dedicated and experienced Registered and Enrolled Nurses to join our growing team, with flexible opportunities starting...

  • Nurse

    24 hours ago

    Bacolod City, Western Visayas, Philippines Borough Medical Care Institute Inc. Full time ₱600,000 - ₱1,000,000 per year

    About the role We are seeking an experienced Nurse to join our dedicated team at the Borough Medical Care Institute Inc. in Bacolod City, Negros Occidental. This full-time position is responsible for providing high-quality nursing care to our patients, ensuring their safety and wellbeing throughout their stay with us.What you'll be doingAssessing, planning,...

  • Company Nurse

    4 weeks ago

    Iloilo City, Western Visayas, Philippines F. Gurrea Group of Companies Full time

    Maintains and records inventory of medical supplies in the clinic and at project sites.Heads the Accident Response Team and conducts regular safety trainings.Provides first aid treatment and proper medication to employees, or accompanies them to the nearest hospital. Monitors and attends to reported accidents.Assists the Company Physician and implements...

  • Clinical Care Navigator

    1 week ago

    Bacolod City, Western Visayas, Philippines beBeeCare Full time

    Care Coordinator Nurse PositionVisaya KPO is looking for a skilled Clinical Care Navigator to join our healthcare team. If you have a passion for patient care and experience in hospital or case management, we want you on board.We are seeking a highly motivated individual with strong clinical background to manage and coordinate chronic care plans, monitor and...