pre claim adr/rcd reviewers

2 weeks ago

Work from Home, Philippines Cliniqon Full time ₱450,000 - ₱600,000 per year

We're Hiring: ADR/RCD Reviewers at Cliniqon

Job location – Remote/ Permanent WFH

Shift timing – Night Shift

JOB DESCRIPTION:

In this role, you will be required to:

  • Review the quick assessment form from ground nurses and transcribing into EMR
  • Performs RCD and ADR review for Home Health and Hospice
  • Gather, reviewer, and compile all necessary clinical documentation required for Pre-Claim Review (PCR)
  • Ensure all submitted documentation is legible, contains valid signatures, and meets Medicare and Palmetto GBA Guidelines
  • Accurately submit review requests through the Palmetto GBA eServices provider portal in a timely manner
  • Diligently monitor the status of all submitted requests
  • Analyze and interpret reasons for non-affirmed or returned decisions from Palmetto GBA
  • Collaborate with clinical staff to obtain corrected or additional documentation needed to resolve deficiencies
  • Stay current with all updates and changes to the Medicare Review Choice Demonstration (RCD) program and Palmetto GBA policies

QUALIFICATIONS:

  • Must be a Registered Nurse
  • At least 1+ year hands-on experience preparing and submitting pre-claim reviews directly to Palmetto GBA
  • In-depth, practical knowledge of the Medicare Review Choice Demonstration (RCD) program and its specific requirements
  • Strong understanding of Medicare Home Health and/or DME documentation, including Face-to-face encounters, Plans of Care (485s), and criteria for skilled needed
  • Experience working with Electronic Medical Record (EMR) or Electronic Health Record (EHR) systems
  • Experience working with ADRs and Medicare Administrative Contracts (MACs) like CGS or NGS
  • Willing to work flexible hours, including night shifts
  • Available for an immediate start

Ready to take the next step in your career? Apply now: or

Job Type: Permanent

Pay: Php35, Php50,000.00 per month

Benefits:

  • Additional leave
  • Company Christmas gift
  • Health insurance
  • Opportunities for promotion
  • Paid training
  • Pay raise
  • Promotion to permanent employee
  • Work from home

Work Location: Remote

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