AGS Health is more than a revenue cycle management company–we’re a strategic partner for growth.  With expert services complemented by AI-enabled technologies and high-touch support, AGS Health is the premier revenue cycle partner for leading health systems, physician groups, and academic medical centers in the U.S. With expert insight into modern revenue cycle practices, the company pairs cutting-edge technology with college-educated, trained RCM experts to help clients optimize workflows, maintain compliance, prevent revenue leakage, and achieve a high-performance revenue cycle. AGS Health employs more than 12,000 team members globally and partners with more than 100 clients 
across a variety of care settings, specialties, and billing systems.

On top of your salary, here are the exciting benefits you can look forward to:

Competitive Remuneration + Annual Performance-based
Bonus + Standard Industry Benefits.

The relocation package, per company policy, will apply to candidates outside the office base city.

 

The main responsibilities of a Registered Nurse - Clinical Services Operations include:

•  Provide health care utilization review services regarding admissions, observations, Discharge 
  Wqs based on the payer types and review types.
• Review admissions and service requests within assigned units for prospective, concurrent, and 
  retrospective medical necessity and/or compliance with reimbursement policy criteria.
• Assist with issues related to coding, medical records/documentation, precertification, 
  reimbursement and claim denials/appeals.
• Notifies attending physician and other members of the health care team of inappropriate 
  admissions, denials, end of authorized days, or other factors that have a reimbursement 
  impact.
• Consults with the attending physician when documentation in the medical record does not support 
  admission or continued stay and seeks to ensure completeness of all clinical documentation.
• Functions as liaison between the Physician Advisor and the attending physician.
• Documents denial information in the electronic medical record system including attempts at 
  resolution/overturning of the denial.
• Provides all payor communication to be scanned into the system for use in appeals.
• Application of MCG and InterQual guidelines for each case review to determine the status.
• Consults with medical and treatment staff regarding client diagnosis, medical justification, 
  length of treatment, and case documentation.
• Participates in utilization and peer review meetings and projects.
• Academic qualification for this role is a graduate in Nursing.
• Required Certifications/Licensure Registered Nurse currently licensed

 

 

To apply, you must be an expert on the following requirements:

• Awareness and implementation of ISO, ISMS, and GRIC policies
• Adherence to the rules and regulations as outlined by the management.

 

It will also be favorable if you are knowledgeable in:

• Excellent written and spoken English
• Unflinching integrity and personal work ethics
• Self-starter who strives for self and team excellence
• Flair for client satisfaction
• Attention to detail and concern for accuracy
• Excellent time management skills and multi-tasking ability
• Excellent team player
• Compliant with rules and regulations

 

The successful candidate must submit the following pre-employment requirements:

• Scanned copy of valid NBI Clearance
• Accomplished Medical or PEME Slip (covered by KMC)
• 2x2 & Half body picture with white background
• Proof of government numbers (TIN, SSS, Pag-ibig, & Philhealth).
• Photocopy of 2 valid IDs – front & back (government-issued)
• Clear copy of your Birth Certificate (PSA or NSO)
• Accomplished HR Forms & Promissory Note (will be provided by KMC’s Onboarding Team)

 

Click here to view the complete list of KMC’s pre-employment requirements.

 

KMC Careers

If you're a rockstar at what you do and looking to be a part of our amazing story, we want to hear from you!

We offer attractive salaries and benefits plus you get to work in some of the Philippines' best flexible workspaces. Our employees also get to enjoy exclusive discounts, rewards and freebies, and invites to our monthly events. We are always recruiting for roles in IT & Development, Marketing, Business Administration, HR & Recruitment and Legal & Finance Roles.

KMC provides quality employment opportunities for job-seekers looking for a career that is both challenging and fulfilling. We are also committed to providing equal opportunities at every selection stage. We do not discriminate due to age, gender, sexual orientation, ethnicity, nationality, and religion.

Work with Us. Grow with Us.

KMC Solutions offers a variety of career opportunities in Metro Manila, Cebu and Clark & Iloilo. We are always looking for talented and enthusiastic individuals who are ready to make their next big career move.

Our Culture

At KMC, we foster an inclusive and positive workplace for all. We push our members to succeed in everything they do through our collaborative work environment. We encourage our community to work hard and reach their full potential while delivering results that matter for our members and you as professionals.

We host amazing and quality events and implement people-centric policies to work flexibly. We ensure that everyone in our expansive network is engaged, from our internal employees and those who work on behalf our offshore partners.

Life within KMC: Work Hard Party Harder

At KMC, we work hard and we are committed to putting our best foot forward in everything we do. Everyone is encouraged to be an individual while also working for the collective good of the KMC Community. We believe mistakes are opportunities and that you should not present a solution without a problem.

We also know when hard work deserves to be recognized so we reward our employees with monthly parties, free trips and much much more!