Responsible for auditing in-patient and/or surgical bills to promote excellence in medical bill review and process improvement.
- Medical Bill Review
- 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.
- Demonstrates knowledge and understanding of Broadspire medical department policies and procedures and ability to communicate same with internal/ external customers as necessary.
- Business Process Support
- 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.
- Demonstrates knowledge and understanding of Broadspire medical department policies and procedures and ability to communicate same with internal/ external customers as necessary.
- Bachelor's degree in Nursing.
- Must have an active and in good standing without restriction Philippine RN license.
- Minimum of one (1) year diverse clinical experience or prior experience in medical bill review or claim/case review.
- Good communication skills.
- Proficient in word processing software applications.
- Analytical skills - Ability to perform basic bill review according to standard operating procedures (SOP).
- 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.
- Must complete continuing education requirements mandated the Professional Regulation Commission.
- Must complete courses as outlined by Crawford Educational Services.
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