Clinical Program Nurse I

Crawford-; Iloilo City; Presencial; PHP 250.000 - 380.000; Jornada completa

Descripción de la vacante

Crawford is seeking a Nursing graduate with an active Philippine RN license to audit inpatient and surgical bills and drive accurate reimbursement decisions. The role involves detailed bill review, discrepancy resolution, and collaboration with physicians and attorneys to support litigation where applicable.

You'll document findings in the billing system, maintain confidentiality, and contribute to process improvements across the medical billing workflow.

Formación

• Bachelor's degree in Nursing required; active Philippine RN license.
• Minimum 1 year clinical or medical bill review experience preferred.
• Proficient in MS Word and general office software.
• Strong analytical mindset with attention to detail and confidentiality.

Responsabilidades

• Audit inpatient and/or surgical bills according to SOPs to ensure accurate processing.
• Clarify billing discrepancies and recommend appropriate reimbursements.
• Document pertinent information in system bill notes to support decisions.
• Collaborate with peer physicians to determine reimbursement amounts.
• Liaise with attorneys for potential litigated claims when needed.
• Support other billing and process-improvement tasks as required.

Conocimientos

Analytical skills

Attention to detail

Confidentiality

Interpersonal skills

Time management

Communication

Educación

Bachelor's degree in Nursing

Herramientas

Microsoft Word

Descripción del empleo

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.