Responsible for providing proactive case management services by assessing existing medical records.
Responsibilities
Case Management Services
Analyzes and reviews case records, evaluates client's medical status, and defines their needs and problems.
Provides opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendation to facilitate rehabilitation goals and return to work.
Utilizes experience and medical resources to interpret medical records and test results, and provide appropriate assessments accordingly.
Reviews cases with immediate superior monthly to evaluate files and obtain directions.
Performs job site evaluations/summaries to facilitate case management process.
Demonstrates knowledge and understanding of Broadspire medical department policies and procedures and ability to communicate same with internal/ external customers as necessary
Client Relations
Establishes professional working relationship with internal and external clients by timely return to work.
Maintains contact with all parties involved on case to appraise them of case activity, case direction, or receive authorization for services.
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
Performs peer reviews and independent medical examination.
Meets monthly production and quality assessment (QA) requirements.
Deals with problem resolution independently by using appropriate research and resources.
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
Qualifications
Bachelor's degree in Nursing.
Must have an active and in good standing without restriction Philippine RN license; Has an active and in good standing without restriction US RN license from any mainland state.
Minimum of two (2) years diverse clinical experience or prior experience in Medical Bill Review.
Excellent verbal communication skills and customer orientation.
Proficient in word processing software applications.
Analytical skills - Ability to perform basic and complex bill review according to standard operating procedures (SOP).
Ability to deliver excellent customer service.
Active listening and phone handling skills.
Critical thinking skills - Ability to make judgements and recommendations.
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.
