Clinical Review Specialist

Company: Change Healthcare Philippines Inc
Website: https://changehealthcare.com
Overview: Change Healthcare is a leading independent healthcare technology and business solutions company that offers software, analytics, network solutions, and technology-enabled services to help create a stronger, more collaborative healthcare system. We help deliver measurable value not only at the point of care, but also before, after, and in between care episodes.

Change Healthcare provides data and analytics-driven solutions and services to help improve clinical, financial, and patient engagement outcomes. We work with payers and providers who want to improve clinical decision-making, simplify billing, collection, payment processes, and enable a better patient experience.

Job Title: Clinical Review Specialist
Location: BGC, Taguig
Salary: Competitive, Dependent on experience
Shift Schedule: Night Shift (9pm-6am)

Job Summary:
The Clinical Review Specialist is responsible for reviewing post service claims to identify aberrant coding and billing patterns through review of related medical records. The Clinical Review Specialist conducts clinical review of medical records and supporting documentation against submitted claims for; professional and facility claims to validate coding and billing accuracy, including complex and forensic reviews as needed.

The successful candidate would also help document clinical review findings within the case tracking system; maintaining thorough, objective, consistent and high-quality reviews, as required by client, CMS, department, and industry standards as well as interface with clients by telephone or correspondence to answer questions and resolve issues relative to review criteria and processes.

Qualifications:
· RN, CPC / COC
· CPT & HCPCS Coding Experience

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