- The role involves conducting SSBV (Short Stay/Bypass Validation) payment‑integrity audits focused on hospital encounters that were billed as inpatient but may meet criteria for outpatient classification. Using InterQual evidence‑based screening criteria, the auditor will review medical records to determine whether the documentation supports an outpatient versus inpatient payment status. These audits do not evaluate the medical necessity of services or the level of care delivered. Instead, the primary objective is to ensure that hospital claims were accurately billed and correctly paid in accordance with established guidelines.
- Must hold an active, unrestricted Doctor of Medicine licensure in the Philippines
- Minimum 2+ years of clinical experience in an adult care inpatient setting with recent hospital experience
- Internal Medicine Diplomate preferred but not required
- Fluent in English Communication; able to communicate with Stateside Medical Doctors and RN
- Must have experience working with computers for professional communication – Excel, Outlook and MS Teams
- Willing to work full-time on a night shift schedule,
- Willing to report in a hybrid setup in Makati
- Market Competitive Pay Levels
- Retirement Plan
- Medical Plan (HMO) from Day 1 of employment
- Dental, Medical, and Optical Reimbursements
- Life and Disability Insurance
- Paid Time-Off Benefits
- Sick Leave Conversion
- Tuition Fee Reimbursement
- Employee Assistance Program (EAP)
- Annual Performance Based Merit Increases
- Employee Recognition
- Training and Staff Development
- Employee Referral Program
- Employee Volunteerism Opportunity
- All Mandatory Statutory Benefits
- Optum is the health care technology and innovation company of the UnitedHealth Group enterprise along with UnitedHealthcare.
- UnitedHealth Group is a health care and well-being company with a mission to help people live healthier lives and help make the health system work better for everyone.
- We're a leading health solution and care delivery organization. Our work is complex, but our mission is simple: create a healthier world, with you at the center.
- As part of a Fortune 4 enterprise, we are improving the health care experience of over 125 million people around the world.
- We're a diverse team with operations across North America, South America, Europe, Asia Pacific and the Middle East. This includes our over 25,000 employees in the Philippines.
- Elevate your career with a leading health care company while improving lives.
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Medical Doctor - Makati - Optum
Paglalarawan
ROLE AND RESPONSIBILITIES
QUALIFICATIONS:
WHAT WE OFFER:
WHO WE ARE:
Join us in evolving health care so everyone can have the opportunity to live their healthiest life. This is your opportunity to be part of a team that's dedicated to Caring. Connecting. Growing together
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