Nurse Medical Billing Auditor (Workers' Comp)

Cognizant Consulting; Philippines; On-site; PHP 360,000 - 540,000; Full time

Job summary

Cognizant Consulting in the Philippines is seeking a detail-oriented nurse to perform intensive medical bill audits. The role involves examining hospital, DME, pharmacy, and home health bills, validating services rendered against reports, and ensuring proper coding in accordance with fee schedules and internal policies.

The successful candidate will leverage the Medical Bill Repricing System to assess accuracy, detect duplications, and make informed payment recommendations.

Qualifications

• Performs intensive medical bill audits to detect duplicates, outliers, potential fraud, and incorrect coding.

Responsibilities

• Review medical hospital, DME, pharmacy, and home health bills for accuracy.
• Read and interpret scanned medical reports using the Medical Bill Repricing System to verify services billed reflect services provided.
• Compare bills and rates with fee schedules and internal guidelines to determine appropriate payments.
• Identify overlaps or duplications of services across bills.
• Apply payment policies to medical supplies and drugs/medicine.
• Provide accurate payment recommendations based on analysis of each bill.

Skills

Medical bill audit

Fraud detection

Coding accuracy

Regulatory knowledge

Bill review

Education

Philippine Licensed Registered Nurse

Tools

Medical Bill Repricing System

Job description

Cognizant Consulting in the Philippines is seeking a detail-oriented nurse to perform intensive medical bill audits. The role involves examining hospital, DME, pharmacy, and home health bills, validating services rendered against reports, and ensuring proper coding in accordance with fee schedules and internal policies.

The successful candidate will leverage the Medical Bill Repricing System to assess accuracy, detect duplications, and make informed payment recommendations.