Work Setu p / Shift : WFO / Night shift
Start Date : ASAP
Qualifications :
- Bachelor's Degree in Nursing (BSN)
- Active USRN License of any state (NY preferred)
- Atleast 1-2 years as a Process Trainer
- Minimum 1-2 years experience in a US Healthcare account (Utilization Management Review and Clinical Appeals)
- Experience with utilization of Interqual / MCG Guidelines
- Exposure to Inpatient / Concurrent reviews
- Must be amenable to report in Manila
Responsibilities :
1. Clinical Review & Auditing :
Review patient medical records to ensure the accuracy and completeness of documentation.Evaluate and verify the appropriateness of medical codes based on patient diagnoses and procedures.Assist in medical coding audits and provide recommendations for improvements.Collaborate with other healthcare professionals to resolve discrepancies in patient records.2. Medical Coding Support :
Work closely with medical coders to ensure compliance with U.S. healthcare regulations and standards.Provide clinical expertise in the identification of proper coding for procedures and diagnoses.Maintain knowledge of the latest updates to ICD-10, CPT, and other coding guidelines.3. Quality Assurance & Compliance :
Ensure that all healthcare documentation aligns with U.S. healthcare laws, policies, and regulations (HIPAA, CMS).Identify trends or recurring issues related to clinical documentation and coding, and escalate as necessary.Participate in training programs to stay updated on U.S. healthcare regulations and clinical practices.