Clinical Bill Review Nurse
2 hours ago
The
Clinical Bill Review Nurse
is responsible for reviewing medical bills and associated documentation to ensure accuracy, medical necessity, and compliance with workers' compensation guidelines. This role supports payment integrity by identifying inappropriate charges, ensuring adherence to jurisdictional fee schedules, and applying clinical expertise to support fair and accurate reimbursement.
Duties And Responsibilities
- Conduct clinical reviews of medical bills to assess medical necessity, appropriateness of care, and alignment with workers' compensation treatment guidelines.
- Identify billing discrepancies such as unbundling, upcoding, duplicate charges, and non-compensable services.
- Apply jurisdiction-specific fee schedules, utilization review (UR) protocols, and treatment guidelines (e.g., ODG, MTUS).
- Collaborate with bill review analysts, adjusters, and medical providers to clarify clinical information and resolve billing issues.
- Document clinical rationale for recommended payment reductions or denials in accordance with regulatory and client requirements.
- Maintain current knowledge of workers' compensation regulations, medical coding (ICD, CPT, HCPCS), and clinical best practices.
- Support quality assurance and continuous improvement initiatives within the bill review process.
Qualifications:
- Active, unrestricted PH RN license (required)
- Minimum of 3 years of clinical experience; experience in workers' compensation or medical bill review strongly preferred
- Familiarity with state-specific workers' compensation regulations and treatment guidelines
- Strong analytical, communication, and documentation skills
- Experience with bill review platforms (e.g., Strataware, Medata, Mitchell) is a plus
All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, ethnicity, age, disability, marital status, or any other characteristic protected by law.
Genfinity as an Equal Opportunity Employer,
believes in each person's potential, and we'll help you achieve yours.
All information will be kept confidential according to EEO guidelines.
Privacy Notice & Consent
We value your privacy. By submitting your information through this form, you are applying for a position at
Genfinity Philippines, Inc.
and voluntarily providing personal information, including your name, contact details, and resume.
This information will be collected and processed
solely for recruitment purposes
, including evaluating your qualifications, assessing your skills, verifying your background, and contacting you about your application. Your personal data will be processed in accordance with the
Data Privacy Act of 2012
.
You have the right to access, correct, or withdraw your data at any time. For more information, please refer to our Privacy Policy or contact our
Data Protection Team
at
.
By submitting this form, I acknowledge that I have read and understood the above Privacy Notice and hereby give my
free, informed, and voluntary consent
to the collection and processing of my personal information by Genfinity Philippines, Inc. for recruitment purposes.
-
Clinical Bill Review Nurse
3 hours ago
Mandaluyong City, National Capital Region, Philippines Genfinity Full time ₱900,000 - ₱1,200,000 per yearThe Clinical Bill Review Nurse is responsible for reviewing medical bills and associated documentation to ensure accuracy, medical necessity, and compliance with workers' compensation guidelines. This role supports payment integrity by identifying inappropriate charges, ensuring adherence to jurisdictional fee schedules, and applying clinical expertise to...
-
Utilization Review Nurse
1 week ago
Quezon City, National Capital Region, Philippines Private Advertiser Full time ₱1,000,000 - ₱2,500,000 per year**What we offer: Salary Package: PHP 50,000 +**Sign-On Bonus: PHP 50,000Work Setup: Onsite at Bridgetowne, Quezon CitySchedule: Shifting ScheduleEssential Duties and ResponsibilitiesAccurately interpret member benefits and managed care products, and guide members to appropriate providers, programs, or community resources.Collaborate with medical directors...
-
Clinic Nurse Supervisor
2 hours ago
Makati City, National Capital Region, Philippines Rhodium Regenerative Institute Full time ₱1,200,000 - ₱2,400,000 per yearClinic Nurse Supervisor (Integrative Clinic)Registered Nurse (RN) with active PRC licenseMinimum 3 years of clinical nursing experience, with at least 1–2 years in a supervisory or leadership role in a clinical or outpatient settingExperience in Integrative or Functional Medicine is a strong advantageWilling and able to perform direct patient care duties...
-
Nurse
3 hours ago
Mandaluyong City, National Capital Region, Philippines OPAT The Antibiotic Care Specialist Full time ₱300,000 - ₱600,000 per yearJob Title: NurseLocation: OPAT.PH ClinicPosition Type: Full-TimeJoin Our Mission of Healing and Specialized CareAre you ready to start or grow your nursing career in a progressive clinical setting? OPAT.PH is looking for compassionate, dedicated Nurses to join our team in delivering specialized care through Outpatient Parenteral Antibiotic Therapy (OPAT) and...
-
Company Clinic Nurse
4 hours ago
Makati City, National Capital Region, Philippines International SOS Full time ₱350,000 - ₱500,000 per yearNOW HIRING: Company Clinic NurseMakati City.JoinInternational SOS, the world's leading provider of medical and security services, and build a rewarding nursing career in a professional corporate environment.We are looking for a skilled and compassionateCompany Nurseto support the health and wellness of employees across our client sites inMakati, Taguig,...
-
In-House Clinic Nurse
2 hours ago
Makati City, National Capital Region, Philippines Maxicare Health Services Inc. Full time ₱276,000 per yearStep into a vital role where care meets corporate. As an In-House Clinic Nurse in a corporate setting, you'll be at the frontlines of employee wellness—offering medical support, promoting workplace health, and creating a safer, more compassionate environment for everyone.What You'll DoYour daily responsibilities include:Provide immediate care: First-aid,...
-
IVT Nurse
4 hours ago
Mandaluyong City, National Capital Region, Philippines HEALTH CUBE Full time ₱840,000 - ₱1,104,000 per yearIVT Nurse (Intravenous Therapy Nurse)Health Cube Medical Clinics_ Shaw, Mandaluyong City_We are looking for a skilled and patient-centered IVT Nurse to join Health Cube Medical Clinics.The role focuses on safe and efficient administration of intravenous therapy for outpatient and diagnostic patients, ensuring quality service and excellent patient care.Job...
-
Bill Review Associate I
3 hours ago
Mandaluyong City, National Capital Region, Philippines Genfinity Full time ₱900,000 - ₱1,200,000 per yearTheBill Review Associate Iis responsible for analyzing and auditing medical billing data to ensure accuracy, proper coding, and compliance with reimbursement policies. The role supports cost containment and quality improvement in healthcare services through effective bill review and interpretation of medical documentation.Key ResponsibilitiesAudit and...
-
ActiveOne: Clinic Manager
3 hours ago
Mandaluyong City, National Capital Region, Philippines RelianceUnited Full time ₱30,000 - ₱90,000 per yearThe Clinic Manager will handle clinic management in terms of daily clinic operations, engagement with staff, guidance in reports, audit compliance, etc. A coordinator and first line to engage with clinic site personnel to address day-to-day concerns. Duties and Responsibilities:Monitors compliance of staff with standards defined by ActiveOne specifically...
-
HDSI: Company Nurse
4 hours ago
Mandaluyong City, National Capital Region, Philippines RelianceUnited Full time ₱360,000 - ₱840,000 per yearGreetings from the RelianceUnited Recruitment TeamThank you for your interest in being part of RelianceUnited's Onsite Clinic Management Team (Flexicare)To start your application process and prepare for a virtual interview, please fill up this form which will take minutes to complete. You will also be required to upload your CV (.doc, .pdf...