Medical Billing Audit Nurse: Claims & Coding

Cognizant; Philippines; On-site; PHP 420,000 - 640,000; Full time

Job summary

Cognizant is seeking a Philippine licensed registered nurse to perform intensive medical bill audits, focusing on duplicates, outliers, potential fraud, and appropriate coding. You will research regulatory fee schedules for Workers' Compensation and review bills under Surgery and Anesthesia product lines.

In this role you will analyze submitted hospital, durable medical equipment, pharmacy, and home health bills for accuracy, determine appropriateness, and issue payment recommendations based on

Qualifications

• Philippine Licensed Registered Nurse.
• Experience in medical bill auditing and coding review.
• Familiar with fee schedules and regulatory guidelines.

Responsibilities

• Perform detailed review of medical bills for accuracy and appropriateness.
• Interpret scanned medical reports using multiple screens to verify services were performed.
• Compare bills and rates with fee schedules and NCCI to determine payment recommendations.
• Compile bills to identify overlap or duplication of services.
• Apply payment policies to medical supplies and drugs.
• Make accurate payment recommendations based on analyses.

Skills

Medical auditing

Nursing knowledge

Regulatory coding

Attention to detail

Education

Philippine Nursing License

Tools

Medical Billing System

Job description

Cognizant is seeking a Philippine licensed registered nurse to perform intensive medical bill audits, focusing on duplicates, outliers, potential fraud, and appropriate coding. You will research regulatory fee schedules for Workers' Compensation and review bills under Surgery and Anesthesia product lines.

In this role you will analyze submitted hospital, durable medical equipment, pharmacy, and home health bills for accuracy, determine appropriateness, and issue payment recommendations based on