Clinical Program Nurse I

About the role

The Clinical Program Nurse I is responsible for auditing inpatient and surgical bills to ensure accurate reimbursement and process improvement. This role combines clinical expertise with detailed medical bill review, supporting both internal teams and external partners.

Key responsibilities

• Review inpatient and surgical bills according to standard operating procedures and turnaround times.
• Identify and clarify billing discrepancies, documenting findings in the system.
• Perform bill reconsiderations when requested and ensure appropriate reimbursement decisions.
• Collaborate with physicians and business process associates on billing issues and fee schedule inquiries.
• Liaise with legal counsel on potential litigated claims and refer complex matters to supervisors.
• Uphold confidentiality standards and the organization’s code of conduct.

Required profile

• Bachelor's degree in Nursing.
• Active Philippine RN license in good standing.
• Minimum one year of clinical experience or prior experience in medical bill or claim review.
• Strong communication, analytical, and interpersonal abilities.
• Ability to multitask, prioritize, and maintain high attention to detail.
• Commitment to continuing education requirements set by the Professional Regulation Commission.

Required skills

• Proficiency with word processing software (e.g., Microsoft Word).