16/10 Reena Gonsalves
Consultant at Innoquest Consulting

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Senior Executive - Nursing - Hospital (5-10 yrs)

Bangalore Job Code: 7889

The aforesaid opportunity is with a business process management (BPM) client that focuses on back office processing, contact centers and HRO solutions.

Position: Sr. Exec

- Mandatory ask for the role: Mandatory NCLEX-RN (National Council Licensure Examination-Registered Nurse) certification / Fresher's may also apply / 4.30PM - 1.30AM shift (Weekends Off)-

Duties and responsibilities:

1. Review medical records and follow stringent protocols to determine whether patients meet the standards for insurance reimbursement.

2. Clinical review for medical necessity of identified claims.

3. Documentation of clinical rationale supporting findings of the review.

4. 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.

5. Have understanding of ICD-9, CPT and HCPCS codes and their application in the US Health insurance domain.

6. Review and validate all information pertaining to the claim.

7. Comply with procedures, regulations, and rules in maintaining medical records.

8. Interacts on a continuous basis with other departments by directing activities towards positive outcomes.

Experience:

- Minimum 2 years clinical experience from a hospital.

- Fresher's may also apply.

Preferred Qualification:

- Nursing Graduate (Bachelors or Masters in Nursing) from registered nursing college in India.

Unique Skills:

- Minimum experience of 1 year working in US Healthcare organization.

- Proficiency in MS Office tools.

- Good verbal and written communication skills.

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