- Processes inpatient and/or surgical bills by adhering to the given standard operating procedures (SOP) and turnaround time to complete the task
- Performs bill review process by utilizing appropriate resources
- Clarifies billing discrepancies to analyze and recommend appropriate reimbursement
- Documents pertinent information in the system bill notes to support reimbursement determination
- Performs reconsideration of bills, as per request, to ensure original bill processing determination is appropriate
- Collaborates objectively with peer physicians to facilitate determination of reimbursement
- Provides assistance to Business Process Associates and other concerned departments with regards to billing issues, inquiries on fee schedules and/or ground rules for a particular state
- Inform appropriate process owner regarding issues related to calculation of reimbursement
- Communicates effectively with persons involved in case management process as needed
- Liaise with company attorneys to assist in possible litigated claims
- Refers matters beyond limits of authority and expertise to immediate superior for direction
- Upholds the Crawford Code of Conduct by protecting the confidentiality of information
- Performs other related tasks as required or needed
- Bachelor's degree in Nursing
- Must be a Philippine Registered Nurse
- Minimum of two (1) year of diverse clinical experience or prior experience in Medical Bill Review.
- Good communication skills
- Proficient in word processing software applications
- Maintains high degree of professionalism and confidentiality
- Ability to multi-task, prioritize and manage time effectively
- Interpersonal skills - Able to work independently and as a team member
- Keen attention to details
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GBSC - Clinical Program Nurse I - Taguig, Philippines, Pilipinas - Crawford & Company (GBSC)
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Paglalarawan
Position Summary
Responsible for auditing in-patient and/or surgical bills to promote excellence in medical bill review and process improvement.
Responsibilities
A. Medical Bill Review
B. Business Process Support
Requirements
