Quality Assurance nurseFGC Plus Bacolod

Job Descriptions
We're hiring more Q.A. NURSES! Missed the last one? Now's your chance! Send your applications today!
Do you have home health care experience? Any work experience in Quality Assurance? We are looking for (3) Nurse QA's who can join the team ASAP! Click "APPLY NOW" or send your updated CV to [Email hidden] and process your application remotely today!
Job Scope:
Quality
Review assessments to determine if the correct conclusion for eligibility of services was reached by the case manager/field clinicians.
Collect data related to assessments and assessment outcomes.
Examine each case for completeness, accuracy and consistency.
Ensure chart completeness by requesting documentation is submitted timely by all clinicians and chart is complete for billing.
Examines data for outliers and researches such cases.
Develop/complete reports that track and trend activities/outcomes.
Act as an advisor to staff on all QA and compliance issues
Perform other duties as may be assigned by management.
Documentation
Document all prior authorizations information including approval dates, billing units, procedure codes, and prior authorization number in patient profile.
Reporting
Completes all required duties, projects and reports in a timely fashion on a daily, weekly or monthly basis per direction of the leadership
Job Qualifications
Previous HMO/insurance and home health care related work experience is a BIG PLUS
Ideal to have at least 6-months experience in the medical billing/healthcare industry
Professional and excellent English communication skills, phone manners, and writing skills
Resourceful and with strong attention to detail
Basic computer knowledge (MS Word, Excel, email, etc.)