Job ID: 9850

  • Oct 7, 2020
  • Picadilly Star - Bonifacio Global City

The Clinical Review Nurse is responsible for reviewing post service claims to identify aberrant coding and billing patterns through review of related medical records.

Responsibilities: Includes, but not limited to:

  • Conducts clinical review of medical records and supporting documentation against submitted claims for; professional and facility claims to validate coding and billing accuracy, including complex and forensic reviews as needed.
  • Independently manage workload that meets or exceeds production and quality goals; ensuring reviews are completed in a timely manner.
  • Documents clinical review findings within the case tracking system; maintaining thorough, objective, consistent and high quality reviews, as required by client, CMS, department, and industry standards.
  • Interfaces with clients by telephone or correspondence to answer questions and resolve issues relative to review criteria and processes.
  • Participates in process improvement activities and encourages ownership of and group participation in improvement initiatives and opportunities for cost savings. The position responsibilities outlined above are in no way to be construed as all-encompassing. Other duties and responsibilities, may be required and/or assigned, as necessary.

EDUCATION:

  • Graduate of BS Nursing
  • Registered Nurse
  • CPC (Certified Professional Coder) or COC (Certified Outpatient Coder) or equivalent experience
  • RN required, with related clinical medical record/claim review experience
  • CPT & HCPCS Coding experience required 
  • Embraces teamwork with strong written and verbal communication skills
  • Local or Remote/Work from home
  • Minimum of 5 years clinical claim review experience 
  • Knowledge of medical terminology

Skills:

  • Working knowledge of coordination of benefits and medical claims processing
  • Strong problem-solving skills 
  • Excellent organizational and interpersonal skills

MicroSourcing offers diversity in career options. We welcome individuality in self-expression without losing the value for team involvement. We are a fresh look at the BPO & KPO industry. Come experience the MicroSourcing life and be part of our growing family.

Cultures and Values

We are a fast growing company but we have always been able to keep the fun, young and intimate atmosphere from the time we started. We strongly believe in transparency and honesty and we always make sure to represent the interests of our employees as much as we represent the interests of our clients.