Clinical Program Nurse I

Crawford & Company; Iloilo City; On-site; PHP 240,000 - 320,000; Full time

Job summary

Crawford & Company is seeking a Nursing graduate with an active Philippine RN license to audit inpatient and surgical bills and support standard operating procedures in medical bill review. The role emphasizes accuracy, documentation, and collaboration with physicians to determine reimbursements.

Ideal candidates will have 1 year of clinical experience or prior bill review exposure, strong communication, and proficiency in word processing software.

Qualifications

• Bachelor's degree in Nursing is required.
• Active Philippine RN license in good standing is required.
• Minimum 1 year clinical experience or medical bill review/claims review experience.
• Strong communication skills are essential.
• Proficient with word processing software and basic computer tasks.

Responsibilities

• Audit inpatient and/or surgical bills following SOPs and turnaround times.
• Perform bill review using appropriate resources and document findings.
• Clarify billing discrepancies to guide reimbursement decisions.
• Document key case information in the system bill notes.
• Reconsider bills upon request to verify accuracy of processing.
• Collaborate with peer physicians to determine reimbursement.
• Uphold Crawford policies and protect confidentiality of information.
• Provide support to other departments on billing issues and fee schedules.

Skills

Communication

Analytical

Multitasking

Time management

Interpersonal skills

Attention to detail

Confidentiality

Education

Bachelor of Nursing

Tools

MS Word

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

• Bachelors 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.