Nurse Reviewer

ACS pro Global Corporation; Bulacan; On-site; PHP 469,000 - 781,000; Full time

Job summary

ACS pro Global Corporation in the Philippines is seeking a Nurse Reviewer to organize and audit rehabilitation and clinical documentation, including MDS, and review codes for accurate PDPM scoring. The role involves examining supporting documents and preparing records for submission to insurance companies for reimbursement.

The candidate will obtain therapy records from NetHealth, perform audits, create checklists, ensure dates and signatures are accurate, and upload documents to SharePoint for

Qualifications

• BSN graduate with a nursing license.
• Excellent verbal and written communication for collaboration with healthcare professionals.
• Understanding of PDPM framework and its impact on documentation and reimbursement.
• Proficient with EHRs and healthcare software.
• Strong medical terminology for accurate documentation.
• Attention to detail ensuring data accuracy and compliance.
• Able to multitask in a fast-paced environment.
• Compliant with HIPAA and confidentiality protocols.

Responsibilities

• Obtain therapy records from the EMR (NetHealth) for rehab records.
• Review claims and diagnosis codes with supporting documents.
• Create checklists to verify document details before review.
• Perform Med B TPE audits and organize NH records and attestations.
• Identify rehab audits requiring orders or summaries and train on process.
• Upload all documents to SharePoint for timely submission to insurers.

Skills

BSN

Strong Communication Skills

PDPM Knowledge

Tech-Savvy

Medical Terminology

Detail-Oriented

Multitasking

HIPAA Compliance

Education

Bachelor of Science in Nursing (BSN)

Job description

Job Description

A nurse reviewer organizes and audits rehabilitation and clinical documentation, including Minimum Data Set (MDS), and reviews codes for accurate PDPM Scoring. They also examine all supporting documents related to codes and diagnoses in the MDS. Organized charts and checklists are then submitted to insurance companies for payment of claims.

Responsibilities

1. Obtain Therapy records from the Electronic Medical Record (NetHealth) for rehab as listed below
   a. Batch Print
   b. Reports
   c. Arrange and Collate this document Typical Sequence is
   d. Ensure that all pertinent details are accurate and included in the document, including dates and signatures.
2. Reviews claims and diagnosis codes and looks for supporting documents.
3. Create a checklist to verify all document details before review.
4. Med B TPE audits (specifically what NH records need to be pulled, move the orders from TT SharePoint and make a complete record, identify late documentation, need for attestation)
5. Rehab Only audits – Identify which ones need Orders, which ones need orders and summary, which are just billing issues, and train on Summary)
6. Upload all documents to SharePoint for review and timely submission to insurance/facility.

Minimum Qualifications

• Bachelor of Science in Nursing (BSN) graduate
• Strong Communication Skills: Demonstrates excellent verbal and written communication abilities, essential for effective collaboration with healthcare professionals and accurate documentation.
• Knowledge of PDPM (Patient-Driven Payment Model): Has a working understanding of the PDPM framework, including its impact on care planning, documentation, and reimbursement in post-acute care settings.
• Tech-Savvy: Comfortable navigating healthcare software, electronic health records (EHR), and other digital tools commonly used in medical and administrative workflows.
• Familiarity with Medical Terminology: Possesses a solid foundation in medical vocabulary, aiding in accurate documentation and efficient communication within clinical environments.
• Detail-Oriented: Maintains high accuracy in data entry, documentation, and task execution, ensuring compliance and quality standards are met.
• Flexible and Able to Multitask: Capable of adapting to shifting priorities and managing multiple tasks simultaneously in a fastpaced work environment.
• HIPAA and Confidentiality Compliance: Understands and adheres to HIPAA regulations and confidentiality protocols, ensuring the protection of patient information and compliance with privacy standards.