SPE-Ins Claims

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

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

Cognizant is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.