66 Medical Review jobs in the Philippines
Medical Review Specialist
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Job Specifications:
1. Graduate of Bachelor's Degree – RN License is required.
2. Minimum of 2 years experience and must have impressive track record in reviewing treatment plans and services to ensure the efficient use of patient utilization systems and quality care using appropriate medical resources.
3. Effective team player. Excellent interpersonal relationship skills and can work and relate well with co-employees, patients, and customers.
4. Must have behavioral sensitivity, maturity, diplomacy and tact in addressing complex situations and handling irate customers.
5. Outstanding oral and written communication skills.
6. Strong ethics and a high level of personal and professional integrity.
7. Must have basic familiarity on government rules and regulations relating to healthcare management.
8. Computer literate and very highly proficient in using MS office programs.
Duties and Responsibilities:
1. Medical Referral
1.1. Inputs and processes authorization requests and authorizations per guidelines and according to defined time and accuracy standards.
1.2. Reviews the health plan and other guidelines to ensure that services being provided to eligible members are within the scope of the benefit plan and contracted providers are being utilized.
1.3. Issues letters of authorization and applies appropriate contracted or negotiated rates using established criteria.
1.4. Provides members with verification of eligibility, interpretation of benefits, and appropriate contracted provider/facility.
1.5. Screens and troubleshoots calls or walk-in's regarding member care within scope of position. Routes members and provider concerns outside that scope to appropriate department or co-employees.
1.6. Maintains effective communication with members, providers, and other TakeCare staff to ensure adherence to company policies, guidelines and processes.
1.7. Corresponds with TakeCare Guam for coordination of members' off-island referrals.
1.8. Administers reports and maintains files of correspondence, medical records, and other documentation, as appropriate, to report status and to support workflow.
2. Medical Review/Medical Management
2.1. Supports the Medical Review Specialist II, Medical Review Supervisor and other members of the Medical Review/Medical Management Team in the review and analysis of medical information in order to determine the medical necessity of continued stay according to review standards.
2.2. Works with the Medical Review/Medical Management Team to determine medical necessity and length of stay based on the consistent application of decision support system and communicates decisions to providers and patients.
2.3. Works with the Medical Review/Medical Management Team in the coordination of discharge planning with physicians, members, families, caregivers and ancillary providers to support the member's continuity of care needs.
2.4. Provides reports on quality-of-care issues. Submits reports and communicates in a timely and effective manner to the Manager of the Medical Referral Office.
2.5. Performs telephonic and onsite review of concurrent patient services and retrospective quality care issues, access, and outcome studies.
2.6. Maintains ongoing database/documentation to monitor all activities/treatment and outcome plans for patients' conformance with organizational and government regulations.
2.7. Ensures that services provided to eligible members are within the benefit plan and appropriate contracted providers are being utilized.
2.8. Coordinates out of area cases ensuring patient receives cost-effective quality care and monitor patient for return to work.
3. Performs other duties that may be assigned from time to time.
Job Summary:
Reports directly to the Utilization Management Team Lead and responsible for reviewing treatment plans and services that are already underway, in order to ensure the efficient use of patient utilization systems and quality care using appropriate medical resources. Also evaluates the quality of care and its conformance with organizational policies, procedures and guidelines, as well as compliance with government regulations.
Peer Review Specialist
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Are you a licensed RN, NP, MD/DO, or Licensed Therapist with experience in behavioral health and insurance reviews? Join us as a Peer Review Specialist, where you'll ensure clients continue receiving the care they need by securing payer authorizations, reviewing documentation, and collaborating with clinical teams.
Rate: 10–$1 /hr
Setup: 100% Remote
Schedule: Full-Time
Position Summary
The Peer Review Specialist will conduct clinical reviews, case consultations, and insurance payer communications to obtain continued stay authorizations across Residential, PHP, and IOP levels of care. You'll play a key role in bridging clinical expertise with payer requirements, ensuring compliance, accurate documentation, and uninterrupted client care.
Key Responsibilities
- Conduct peer reviews and case consultations with insurance payers to secure continued authorizations.
- Review client charts, including progress notes, psych evaluations, nursing assessments, and lab reports.
- Collaborate with clinical/medical staff to gather updated information supporting medical necessity.
- Apply payer criteria (ASAM, MCG, InterQual) during reviews.
- Accurately document all interactions in EMR or designated systems.
- Track authorizations, expirations, and review timelines to avoid service interruptions.
- Participate in interdisciplinary team meetings and advise on documentation practices.
- Uphold HIPAA, payer requirements, and ethical standards.
Required Qualifications
- Minimum: Licensed RN
- Preferred: NP, MD/DO, LCSW, LPC, LMFT, PsyD, or PhD
- 2+ years of experience in behavioral health, substance use, or psychiatric care
- Prior experience in utilization review, case management, or insurance authorization preferred
- Familiarity with payer platforms and guidelines
- Excellent communication and documentation skills
- Strong attention to detail, ability to work under pressure, and independently
What We Offer
- Competitive pay: 10–$1 /hr
- 100% remote work setup
- Full-time, stable role with career growth potential
- Opportunity to make a direct impact on client care access
How to Apply
Send your resume to with subject line:
Peer Review Specialist Applicant | JobStreet | (Your Name)
Nurse - Medical documentation review for AI company
Posted today
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Join a fast-growing US-based healthcare AI company.
We currently have openings for Daytime and Evening (PH time) schedules, as well as weekend availability. Whether you're looking for a part-time opportunity or a full-time role, we'd love to hear from you
Join a passionate team that's redefining patient care
We help nurses save time and focus on what matters most—delivering exceptional care. You'll be working alongside an incredibly skilled team of RNs and PTs from both the Philippines and the US who are dedicated, experienced, and genuinely love what they do.
WHAT YOU'LL DO:
Detailed review of medical documentation and data entry / QA review.
REQUIREMENTS:
1 - Nursing, PT or pharmacy background
2 - Extremely detail-oriented
3 - Fast-learner and comfortable with change
WHY WORK WITH US:
1 - Fun and fast-paced environment
2 - Accelerated career growth / leadership
3 - Learn about the future of AI from world-class developers
SET-UP: Work-from-home
Job Types: Full-time, Part-time
Pay: Php70, Php100,000.00 per month
Benefits:
- Flexible schedule
- Flextime
- Paid training
- Work from home
Work Location: Remote
Document Review Specialist II - Medical Writing
Posted 12 days ago
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Other
**Environmental Conditions**
Office
**Job Description**
At Thermo Fisher Scientific, you will discover meaningful work that makes a positive impact on a global scale. Join our colleagues in bringing our Mission to life - enabling our customers to make the world healthier, cleaner, and safer.
We provide our teams with the resources needed to achieve individual career goals while taking science a step beyond through research, development, and delivery of life-changing therapies. With clinical trials conducted in 100+ countries and ongoing development of novel frameworks for clinical research through our PPD clinical research portfolio, our work spans laboratory, digital and decentralized clinical trial services. Your determination to deliver quality and accuracy will improve health outcomes that people and communities depend on - now and in the future.
**Summarized Purpose:**
We are excited to be growing our Medical Writing Functional Service Partnership (FSP) Team in APAC. We are seeking a Document Review Specialist II who will be dedicated to one or more clients in the FSP space, experience working in a range of document management systems would be preferred. As a remote-based Document Review Specialist within the FSP Team, you will review regulatory documents, including but not limited to submissions documents, protocols and amendments, clinical study reports, investigator's brochures, and patient safety narratives, to ensure quality standards and adherence to templates, client guidelines, editorial style guides, and industry standards. You will collaborate with internal clients, supporting and enabling effective communication and quality deliverables. This role requires meticulous attention to detail, a high English proficiency with the ability to communicate clearly and concisely, and understanding of regulatory document content.
**Key Responsibilities:**
+ Reviews highly technical scientific documents of all types developed within or outside of the company to ensure quality standards that meet or exceed client expectations.
+ Verifies scientific logic and clarity of the document by verifying data in tables, listings, and figures against source documents, checking for consistency according to current regulatory standards and guidelines.
+ Edits for accuracy, consistency, and grammatical correctness.
+ Adjusts schedule to accommodate unexpected requests for priority review.
+ Revises scientific language for usage, flow, clarity, and audience appropriateness.
+ Proactively queries authors to ensure compatibility with unique preferences and scientifically sound judgment.
+ Maintains, communicates, and applies knowledge of current guidelines, templates, and industry standards.
**Education and Experience:**
+ Bachelor's degree or equivalent and relevant formal academic/vocational qualification required.
+ Previous experience that provides the knowledge, skills, and abilities to perform the job (comparable to 2+ years).
+ Experience working in the pharmaceutical/CRO industry preferred.
+ If CRO experience: experience working in a client-dedicated role or with 1 to 2 clients over multiple projects
+ In some cases, an equivalency, consisting of a combination of appropriate education, training, and/or directly related experience, will be considered sufficient for an individual to meet the requirements of the role.
**Knowledge, Skills, and Abilities:**
+ Capable of focusing on document details and the overall objectives and intent of document messaging.
+ Good knowledge of the methods, techniques, and procedures of medical writing tasks.
+ Strong analytical ability.
+ Good working knowledge of medical terminology, statistical concepts, GCP, guidelines (e.g., ICH), and requirements of the FDA and other international regulatory agencies.
+ Attentive to detail and quality of documents, thorough and methodical.
+ Proficient oral and written communication and grammatical skills.
+ Good organizational and planning skills.
+ Good interpersonal skills.
+ Good knowledge and understanding of document management systems.
+ Proven ability to work effectively in a team environment.
+ Advanced computer literacy and expertise.
+ Capable of working well under pressure and remaining motivated.
+ Capable of working both independently and collaboratively with a team in a cross cultural, geographically dispersed environment.
**What We Offer:**
Our Mission is to enable our customers to make the world healthier, cleaner, and safer. As one team of 100,000+ colleagues, we share a common set of values - Integrity, Intensity, Innovation, and Involvement - working together to accelerate research, solve complex scientific challenges, drive technological innovation, and support patients in need. #StartYourStory with PPD, part of Thermo Fisher Scientific, where diverse experiences, backgrounds and perspectives are valued.
Thermo Fisher Scientific is an EEO/Affirmative Action Employer and does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability or any other legally protected status.
USRN Healthcare Utilization Review
Posted today
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At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees are key factors in our company's growth, market presence and our ability to help our clients stay a step ahead of the competition. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here.
In this Role you will be Responsible For:
- Assembles and maintains patients' health information in medical records and charts.
- Ensures all forms are completed and properly identified and filed.
- Ensures activities comply with state and federal regulations on how to handle medical record requests. Maintains patient confidentiality.
- Performs more complex quality assurance checks on medical records.
- Codes and abstracts information from a variety of medical records and assigns appropriate codes based on medical documentation
- Follows strict coding guidelines within established productivity standards for all accounts assigned.
- Uses transcribing and word processing equipment, transcribes medical, technical, and personal patient information to support clinical documentation and revenue cycle functions as outlined in specific contract agreement.
- Checks and distributes reports and files in patient records. Maintains patient confidentiality.
Key Skills:
- Registered Nurse with current, unrestricted US Registered Nurse license
- Good reading and understanding skills - Medical record analysis to understand the procedure performed and the reason for which it was done.
Medical Records Reviewer
Posted today
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Job Description
Portiva started in 2009 with our mission to help Doctors and Medical Practitioners manage their practices better. Since then, Portiva has grown from a 3-person operation to one of the largest and most successful Medical and Dental Staff Providing Companies in the United States.
We are looking for an experienced Medical Records Reviewer to provide administrative support to US-based doctors, nurses, or other healthcare professionals in their clinical practice.
This is a work-from-home opportunity.
This is a full-time position, 30-40 hrs a week
The rate is $7 an hour or Php 61,000+ per month
A Medical Records Reviewer plays a crucial role in ensuring smooth operations in a medical facility. Their responsibilities often include but not limited to:
- Accurately upload therapy notes to patient profiles on time.
- Meet and maintain company production expectations.
- Communicate effectively with team members.
- Consistently perform with a high level of attention to detail and accuracy.
- Adapt quickly to changes in process, software, or documentation requirements.
- Support the overall administrative operations of the therapy documentation process.
Requirements and skills
- Ability to adapt to a fast-changing environment.
- Basic knowledge of the health care industry, preferably home health.
- Proficiency in Microsoft Excel and the ability to work with various digital systems.
- Strong organizational and time management skills.
- A minimum of 1 year of experience as a Medical Records Revewer or a Virtual Assistant with a Home Health experience and has experience in reviewing therapy notes/ medical records, or creating charts is required
- Bachelor's degree in Pharmacy, Nursing or Medical Technology is required.
- Excellent English speaking skills (both oral and written proficiency)
- Strong knoweledge with medical terminologies.
- Strong interpersonal skills and a patient-centered approach
- HIPAA Certification is not required but highly desirable.
If this sounds like you, please complete this form:
We will ONLY accept applications via the Google form above.
We will contact you within 3-5 days if you fit the requirements.
*Important Note*: Please make sure to check your spam or junk folders for the initial assessment invite. Sometimes, our emails may get filtered, and we wouldn't want you to miss this important step in the hiring process If you find our email there, be sure to move it to your inbox and mark it as "Not Spam" to ensure you receive all future emails from us directly in your inbox
Good luck
Job Type: Full-time
Pay: Php60, Php65,000.00 per month
Work Location: Remote
Medical Records Reviewer
Posted today
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Job Description
- Responsible for examining and analyzing the patient medical records for timeliness, accuracy and completeness
- Prepares report summaries presentations and needed forms of identified compliance and non-compliance of Patient Medical Records
Qualifications
- Graduate of any Healthcare related course
- With work experience handling medical records reviewing or auditing
- Open for Project-hire employment for 8 months
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Medical Records Nurse
Posted today
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- Accurately encodes data and ensures precise results in the Medical Examination Certificate.
- Verifies completion of all required medical tests according to the patient's emailed Medical package.
- Ensures timely issuance of medical test results and certificates.
- Organizes and maintains medical top sheets, laboratory reports, and other records related to examinations for each client.
- Assists the examining physician during patient physical examinations.
- Releases medical results promptly to partner agencies and walk-in patients.
- Prepares and sends transmittal reports to agencies via email or sometimes on the agency itself.
- Responds to inquiries from applicants and agencies regarding medical results.
- Compiles and submits monthly reports to the Department of Health (DOH).
- Maintains cleanliness and organization of the assigned workstation and department.
- Performs additional duties as assigned by the Medical Director or President.
QUALIFICATIONS:
- PRC License
- Good oral and written communication skills
- Very good interpersonal skills and patient rapport
- Willing to be assigned to Records Department and undergo training
- Experienced as a Records Nurse is a plus
SCHEDULE:
MON - 7:00AM - 4:00PM , SATURDAY - 7:00AM - 11:00AM
Medical Records Specialist
Posted today
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Job Description
Essential Functions:
· Files records daily in appropriate sections of patient charts and maintains charts in proper order.
· Maintains chronological order in placing reports in patient records.
· Copies patient information and forwards to requesting party/referring physician after receiving appropriate consent to release medical records
· Ensures medical record availability by routing records to appropriate staff. · Provides medical record information by answering questions and requests of patients, hospital staff, law firms, insurance companies, and government agencies.
· Maintains patient confidence and protects organization operations by keeping information confidential, following release-of-information protocols.
· Conserves resources by using equipment and supplies as needed to accomplish job results. · Contributes to team effort by accomplishing related results as needed. · Assists in care and maintenance of department equipment and supplies
Knowledge, Skills and Abilities
· Ability to organize and prioritize tasks effectively
· Strong attention to detail
· Ability to effectively communicate with patients and outside sources regarding records
· Knowledge in HIPAA law
· Ability to file correctly by alphabetic and numeric system
· Knowledge and experience in using office equipment including computers, EHR system, word, multi telephone systems, and photocopier
· Able to meet deadline requirements for different record requests
· Bilingual in Spanish is preferred
· Knowledge of medical terminology
Competencies/Personality Traits
● Fluent in English
● Ability to organize and prioritize tasks effectively
● Strong attention to detail
● Ability to effectively communicate with patients and outside sources regarding records
● Knowledge in HIPAA law
● Ability to file correctly by alphabetic and numeric system
● Knowledge and experience in using office equipment including computers, EHR system, word, multi telephone systems, and photocopier
● Able to meet deadline requirements for different record requests
● Bilingual in Spanish is preferred
● Knowledge of medical terminology
● With background in PARS
Prior Experience
· 1-3 years of experience in medical records
· 1-3 years of customer service experience
· Experience in general clerical preferred with some exposure to medical terminology.
· College Graduate of any other course.
Work Condition:
- Pure work onsite in Eastwood, Quezon City
- No Options for WFH.
- Nightshift Schedule
Medical Records Specialist
Posted today
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The Medical Records Specialist is responsible for analyzing claims eligible for arbitration. This individual should possess superior communication and computer skills including familiarity, Microsoft Outlook, Word and Excel. This individual will review, analyze and report reimbursement of integrity measures.
Job Overview:
Employment type: Full-time
Schedule: Night shift
Work setup: Onsite
Site Assignment: PNB Makati
Role Overview:
- Analyze claim reports to determine claims eligible for Arbitration for both ERISA/NSA claims as well as state insurance department claims
- Prepare claims for submission to the appropriate portals for arbitration
- Have the ability for re-prioritize key tasks and meet with manager and director to provide updates of findings and outcomes
- Work with external vendors such as State Department of Insurance (DOI) personnel and arbitrators to assist with issues and resolutions
- Complete special projects and other duties as assigned
Qualifications:
- Minimum of 1 year Medical Billing/Collections Management Experience
- Knowledge of laws that regulate communication and privacy acts. HIPAA laws and understanding of the application of all above
- Must maintain professional appearance.
- Ability to be at work on a regular and consistent basis
- Strong computer skills including Microsoft Office with a strong proficiency in Excel spread sheets, using formulas, pivot tables, filters, etc.
- Strong organizational, analytical, and problem-solving skills
- Knowledge of the insurance industry
- Proven success in negotiation and technical writing
- Professionalism in all dealings, both internal and external
- Ability to clearly communicate, both verbally and in writing
- Knowledge of medical terminology
- Other duties as assigned
Job Type: Full-time
Pay: Php28, Php30,000.00 per month
Benefits:
- Health insurance
Application Question(s):
- Do you have knowledge in HIPAA Regulations?
- How many years of experience do you have working in Healthcare Industry?
- Can you work on a Night Shift?
- Have you supported a US based client?
- Are you willing to work fully onsite in Makati?
Experience:
- Medical records: 1 year (Preferred)
Work Location: In person