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.
Interacts on a continuous basis with other departments by directing activities towards positive outcomes.
Registered Nurse– Hiring Profile
• 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
• Minimum experience of 1 year working in US Healthcare organization
• Proficiency in MS Office tools
• Good verbal and written communication skills
Maximum Salary – 5 LPA
Process 1: Multi Speciality Coding – Denial Management Payer side.
CPC certification must
Exp: 0 to 18 months
CTC: 2.5 to 3.5 LPA
Process2: E/M Coding or Auditing
CPC Certification must
Exp: 0 – 3 years
CTC: 2.5 to 3.75 LPA
5 days’ work 2 days off.
Attractive OT and Holiday pay.
Note- all are US process and will be working in US shift i.e. 4.30 PM or 5.30 PM log in and two way transportation will be provided free of cost.
Salary: 3.50 LPA
Interested candidates, please share your profiles to email@example.com
Don't forget to mention Indian Clinical Reviewers or Medical Coders, Bangalore
in subject line