Nursing Professional - BPO (0-3 yrs)
Nclex - Registered Nurse- Job Description
- Review medical records and follow stringent protocols to determine whether patients meet the standards for insurance reimbursement.
- Clinical review for medical necessity of identified claims.
- Documentation of clinical rationale supporting findings of the review.
- Apply clinical judgment, honed over years in acute care settings, to make responsible decisions that promote appropriate records review and applications usage while keeping resources available to those most in need.
- Have understanding of ICD-9, CPT and HCPCS codes and their application in the US Health insurance domain.
- Review and validate all information pertaining to the claim.
- Comply with procedures, regulations, and rules in maintaining medical records.
- Identifies additional opportunities for savings beyond application of the jurisdictional fee schedule and standard systematic application of coding logic.
- Interacts on a continuous basis with other departments by directing activities towards positive outcomes.
Registered Nurse- Hiring Profile
Desirable skillsets
- NCLEX certification (Mandatory)
- Nursing Graduate (Bachelors or Masters in Nursing) from registered nursing college in India
- Clinical experience of minimum 2 years for working in a hospital
- Proficiency in English grammar & good writing skills
Preferable Skillsets
- Minimum experience of 1 year working in US Healthcare organization
- Proficiency in MS Office tools
- Good verbal and written communication skills
Interested candidate can send your updated resume
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