GBSC - Clinical Program Nurse I

• 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.
• Must complete continuing education requirements mandated the Professional Regulation Commission.
• Must complete courses as outlined by Crawford Educational Services.
• 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.

Crawford & Company