Clinical Program Nurse I — Medical Bill Review Pro

Crawford & Company; Iloilo; Presencial; PHP 300 000 - 540 000; Tempo integral

Resumo da oferta

Crawford & Company is seeking a Nursing professional in Iloilo to audit inpatient and/or surgical bills for medical bill review and process improvement.

The role requires an active Philippine RN license and a Bachelor’s degree in Nursing, plus at least one year of clinical experience or prior exposure to medical bill review. Strong communication, confidentiality, and analytical skills are essential for success, with adherence to SOPs and company guidelines.

Qualificações

• Bachelor's degree in Nursing.
• Active Philippine RN license in good standing.
• Minimum of one year clinical experience or prior medical bill review experience.
• Good communication skills.
• Proficient in word processing software.
• Analytical skills to perform basic bill review according to SOP.
• Maintains professionalism and confidentiality.
• Ability to multi-task, prioritize and manage time effectively.
• Interpersonal skills to work independently and as a team member.
• Keen attention to details.
• Must complete continuing education requirements mandated by the Professional Regulation Commission.
• Must complete courses as outlined by Crawford Educational Services.

Responsabilidades

• Audit inpatient and/or surgical bills by adhering to SOP and turnaround time.
• Perform bill review using appropriate resources.
• Clarify billing discrepancies to analyze and recommend reimbursement.
• Document pertinent information in system bill notes to support reimbursement determination.
• Perform reconsideration of bills upon request to ensure appropriate processing.
• Provide business process support to associates and other departments with billing issues and fee schedules.
• Inform process owners regarding issues related to calculation of reimbursement.
• Communicate with case management process participants as needed.
• Liaise with company attorneys to assist in litigated claims.
• Refer matters beyond limits of authority to immediate superior.
• Uphold Crawford Code of Conduct and confidentiality.
• Perform other related tasks as required.
• Demonstrate knowledge of Broadspire medical department policies and communicate them to internal/external customers.

Conhecimentos

Communication

Analytical

Multitasking

Interpersonal

Attention to detail

Confidentiality

Formação académica

Bachelor's degree in Nursing

Philippine RN license

Ferramentas

Word processing software

Descrição da oferta de emprego

Crawford & Company is seeking a Nursing professional in Iloilo to audit inpatient and/or surgical bills for medical bill review and process improvement.

The role requires an active Philippine RN license and a Bachelor’s degree in Nursing, plus at least one year of clinical experience or prior exposure to medical bill review. Strong communication, confidentiality, and analytical skills are essential for success, with adherence to SOPs and company guidelines.