Clinical Program Nurse I - Medical Bill Review Specialist

Offres d’emploi Crawford - Mondiales; Manila; On-site; PHP 420,000 - 640,000; Full time

Job summary

Crawford - Mondiales in the Philippines is seeking a Registered Nurse with experience in medical bill review to audit inpatient and surgical bills, ensure accuracy, and support reimbursement decisions. The role requires strong analytical skills, adherence to SOPs, and collaboration with physicians and legal teams as needed.

The candidate should hold an active Philippine RN license and have at least one year of relevant clinical or bill-review experience, with proficiency in standard office

Qualifications

• Bachelor's degree in Nursing and active Philippine RN license required.
• 1 year of diverse clinical experience or medical bill review experience preferred.
• Proficiency in word processing software and basic data handling required.
• Strong analytical skills and ability to follow SOPs for bill review.

Responsibilities

• Audit inpatient and/or surgical bills to ensure accuracy and adherence to SOPs.
• Review and process bills within required turnaround times.
• Clarify billing discrepancies and recommend reimbursement.
• Document notes in the system to support reimbursement decisions.
• Conduct bill reconsiderations when requested to ensure accuracy of original determinations.
• Collaborate with physicians and other stakeholders to determine reimbursement.
• Communicate policy procedures to internal and external customers as needed.
• Assist in related billing process issues and liaise with attorneys when required.

Skills

Clinical experience

Analytical skills

Multitasking

Time management

Interpersonal skills

Attention to detail

Professionalism

Education

Bachelor's degree in Nursing

Philippine RN license

Continuing education (PRC)

Crawford Educational Services courses

Tools

Word processing software

Job description

Crawford - Mondiales in the Philippines is seeking a Registered Nurse with experience in medical bill review to audit inpatient and surgical bills, ensure accuracy, and support reimbursement decisions. The role requires strong analytical skills, adherence to SOPs, and collaboration with physicians and legal teams as needed.

The candidate should hold an active Philippine RN license and have at least one year of relevant clinical or bill-review experience, with proficiency in standard office