How You’ll Make an Impact:

• Review medical records in relation to the services billed on claims
• Collaborate with Medical Directors to obtain determinations where medical necessity is unclear
• Coordinate referrals from non-clinical staff for clinical case reviews
• Ensure claims adhere to all regulatory requirements before final processing
• Handoff cases back to non-clinical staff for letter creation and claim adjustments

Key strengths for this role:

• Must be a college graduate
• Active license or certification for USRN
• Basic knowledge of troubleshooting and computer navigation
• Background in clinical review or medical claims processing
• Willing to work onsite
• Must be residing in DAVAO