DRG Nurse Auditor |Nurse Auditor | Taguig

Join Access Healthcare Manila as a DRG Nurse Auditor. We are seeking talented individuals to join our team and help drive our success.

Apply now and take the next step in your career today. We will provide free training on the client’s medical billing software to perform this role.

Tasks:

• Conduct initial audit reviews to validate billed diagnoses and DRG code are supported by medical records
• Record Audit results and document finding notes based on policies using professional clinical resources
• Perform provider appeals reviews and render decision to either uphold or overturn original finding
• Review questionable encoder results, complex cases, and appeal reviews to facilitate referrals to clinical department as needed
• Propose new audit concepts supported by your research and analysis
• Define new audit concept criteria and test and validate new concepts developed by analytics team

Escalate facility issues per client guidance

• Must be Philippine Registered Nurse (with Active license)
• Must have an experience in clinical and audit in IP DRG
• Good Comprehension and writing skills are required to provide the findings to physician
• Curiosity and willingness to ask questions
• Strong attention to detail, organized and thorough
• Strong verbal and written communication skills
• Ability to understand client guidelines related to insurance advantage claims