Clinical Program Nurse I

Offres d’emploi Crawford - Mondiales; Iloilo; On-site; PHP 300,000 - 420,000; Full time

Job summary

Offres d’emploi Crawford - Mondiales in the Philippines seeks a Nursing professional to audit inpatient and surgical bills according to SOPs and ensure accurate reimbursements.

The role requires clinical experience, Philippine RN licensure, and strong analytical, communication, and confidentiality skills to collaborate with physicians and legal professionals while upholding Crawford standards.

Qualifications

• Bachelor's degree in Nursing.
• Must have an active and in good standing Philippine RN license.
• Minimum of one (1) year diverse clinical experience or prior experience in medical bill review or claim/case review.
• 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 and Crawford Education Services.

Responsibilities

• Audit inpatient and/or surgical bills by adhering to 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.
• 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.

Skills

Analytical skills

Interpersonal skills

Multi-tasking

Attention to detail

Professionalism

Education

Bachelor's degree in Nursing

Tools

Word processing software

Job description

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.
• 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.