Clinical Bill Review (PHRN) at Genfinity Philippines, Inc.

Mandaluyong, Metro Manila, Philippines -

Full Time

Start Date

Immediate

Expiry Date

15 Jan, 26

Salary

0.0

Posted On

17 Oct, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Review, Medical Necessity, Billing Discrepancies, Utilization Review, Workers' Compensation, Medical Coding, Analytical Skills, Communication Skills, Documentation Skills, Collaboration, Quality Assurance, Continuous Improvement, Regulatory Compliance, Fee Schedules, Treatment Guidelines, Bill Review Platforms

Industry

Outsourcing and Offshoring Consulting

Description

The Clinical Bill Review Nurse is responsible for reviewing medical bills and associated documentation to ensure accuracy, medical necessity, and compliance with workers’ compensation guidelines. This role supports payment integrity by identifying inappropriate charges, ensuring adherence to jurisdictional fee schedules, and applying clinical expertise to support fair and accurate reimbursement. Duties and Responsibilities: Conduct clinical reviews of medical bills to assess medical necessity, appropriateness of care, and alignment with workers’ compensation treatment guidelines. Identify billing discrepancies such as unbundling, upcoding, duplicate charges, and non-compensable services. Apply jurisdiction-specific fee schedules, utilization review (UR) protocols, and treatment guidelines (e.g., ODG, MTUS). Collaborate with bill review analysts, adjusters, and medical providers to clarify clinical information and resolve billing issues. Document clinical rationale for recommended payment reductions or denials in accordance with regulatory and client requirements. Maintain current knowledge of workers’ compensation regulations, medical coding (ICD, CPT, HCPCS), and clinical best practices. Support quality assurance and continuous improvement initiatives within the bill review process. Qualifications: Active, unrestricted PH RN license (required) Minimum of 3 years of clinical experience; experience in workers’ compensation or medical bill review strongly preferred Familiarity with state-specific workers’ compensation regulations and treatment guidelines Strong analytical, communication, and documentation skills Experience with bill review platforms (e.g., Strataware, Medata, Mitchell) is a plus ------------- All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, ethnicity, age, disability, marital status, or any other characteristic protected by law. Genfinity as an Equal Opportunity Employer, believes in each person’s potential, and we’ll help you achieve yours. All information will be kept confidential according to EEO guidelines. Privacy Notice & Consent We value your privacy. By submitting your information through this form, you are applying for a position at Genfinity Philippines, Inc. and voluntarily providing personal information, including your name, contact details, and resume. This information will be collected and processed solely for recruitment purposes, including evaluating your qualifications, assessing your skills, verifying your background, and contacting you about your application. Your personal data will be processed in accordance with the Data Privacy Act of 2012. You have the right to access, correct, or withdraw your data at any time. For more information, please refer to our Privacy Policy or contact our Data Protection Team at dpo@genfinity.net . By submitting this form, I acknowledge that I have read and understood the above Privacy Notice and hereby give my free, informed, and voluntary consent to the collection and processing of my personal information by Genfinity Philippines, Inc. for recruitment purposes.

Responsibilities

The Clinical Bill Review Nurse reviews medical bills and associated documentation for accuracy and compliance with workers’ compensation guidelines. This role involves identifying inappropriate charges and ensuring adherence to jurisdictional fee schedules.