Clinical Program Nurse I – Medical Bill Review

About the role

The Clinical Program Nurse I will focus on reviewing inpatient and surgical bills to ensure accurate reimbursement and support process improvement within the medical billing department.

Key responsibilities

• Audit inpatient and/or surgical bills according to standard operating procedures and turnaround times.
• Identify and clarify billing discrepancies, document findings, and recommend appropriate reimbursement.
• Perform bill reconsiderations when requested and collaborate with peer physicians on reimbursement decisions.
• Provide business process support by assisting with billing inquiries, fee‑schedule questions, and liaising with attorneys on potential litigated claims.
• Maintain confidentiality, uphold company code of conduct, and refer complex matters to supervisors.

Required profile

• Bachelor’s degree in Nursing.
• Active Philippine RN license in good standing.
• Minimum one (1) year of diverse clinical experience or prior experience in medical bill or claim review.
• Strong communication, analytical, and interpersonal abilities.
• Ability to multitask, prioritize, and manage time effectively while maintaining high attention to detail.
• Commitment to continuing education requirements mandated by the Professional Regulation Commission and company‑specified courses.

Required skills

• Proficiency with word processing software applications.