SPE-Ins Claims

Cognizant; Cebu City; On-site; PHP 300,000 - 520,000; Full time

Job summary

Cognizant in Cebu City is seeking a Nurse Auditor to perform intensive medical bill audits, ensuring accurate coding, detection of duplicates, outliers, and potential fraud. The role requires reviewing bills under Surgery and Anesthesia and researching regulatory fee schedules for Workers’ Compensation.

Responsibilities include detailed bill reviews, using the Medical Bill Repricing System, comparing to fee schedules, and delivering precise payment recommendations based on analyses of each bill.

Qualifications

• Philippine Licensed Registered Nurse is required.

Responsibilities

• Performs a detailed review of submitted medical hospital durable medical equipment pharmacy home health bills along with accompanying reports information for accuracy and to determine appropriateness
• Using multiple screens on the Medical Bill Repricing System read and interpret scanned medical reports to determine that services on bill were actually performed and coded to reflect the services that were actually provided
• Compare bill and rates with appropriate fee schedules clinical edits Medicare National Correct Coding Initiative NCCI internal protocols to determine appropriate payment recommendations
• Compile all medical bills to determine if there is overlap or duplication of any services
• Apply payment policies to medical supplies and drugs/ medicine
• Make accurate payment recommendations based on the results and analysis of each medical bill

Education

Philippine Licensed Registered Nurse

Job description

Job Summary

Performs an intensive and detailed medical audit of bills to detect duplicates outliers potential fraud and inappropriate coding potential overutilization and full research of regulatory fee schedule for Workers Compensation. Nurses review all bills that are under Surgery and Anesthesia product

Job Summary

Performs an intensive and detailed medical audit of bills to detect duplicates outliers potential fraud and inappropriate coding potential overutilization and full research of regulatory fee schedule for Workers Compensation. Nurses review all bills that are under Surgery and Anesthesia product

Responsibilities

• Performs a detailed review of submitted medical hospital durable medical equipment pharmacy home health bills along with accompanying reports information for accuracy and to determine appropriateness
• Using multiple screens on the Medical Bill Repricing System read and interpret scanned medical reports to determine that services on bill were actually performed and coded to reflect the services that were actually provided
• Compare bill and rates with appropriate fee schedules clinical edits Medicare National Correct Coding Initiative NCCI internal protocols to determine appropriate payment recommendations
• Compile all medical bills to determine if there is overlap or duplication of any services
• Apply payment policies to medical supplies and drugs/ medicine
• Make accurate payment recommendations based on the results and analysis of each medical bill

Certifications Required

• Philippine Licensed Registered Nurse