DE033514-Health Clinical Services Analyst

---ONLY THOSE APPLICANTS WHO ALREADY HAVE THE RIGHT TO LIVE AND WORK IN THIS COUNTRY ARE ELIGIBLE TO APPLY FOR THIS ROLE--- POSITION TITLE: Health Clinical Services Analyst WORK SETUP: Return to Office RESPONSIBILITIES: • Determines contract; verifies eligibility and benefits. • Conducts a thorough provider radius search in client system and follows up with provider on referrals given. • Checks benefits for facility-based treatment. • Obtains intake (demographic) information from callers, e-Reviews, and/or from faxes. Processes incoming requests, collection of non-clinical information needed for review from providers, utilizing scripts to screen basic and complex requests for pre-certification and/or prior authorization. • Performs data entry of contact into client systems and routes as appropriate. • Matches fax/clinical records with appropriate case. • Consolidates inputs for approval. • Generates the needed letters as directed by the client and/or outlined in the client’s procedure manual. • Assigns cases/activities and work within the client’s system to facilitate workflow and productivity goals. • Refers cases requiring clinical review to a nurse reviewer. Performs case checks and reviews to ensure case creation is complete and correct for the clinician • Tasks cases accurately to the correct queue. • Conducts outbound scripted calls to providers to request clinical information as directed by the clinician. • Conducts outbound scripted calls to providers to complete approval notification process as directed by the clinician. • Performs Daily Task list maintenance activities under the direction of the Team Lead/Operations Manager and as per customer workflow. • Provides administrative support to Nurse Reviewer via case preparation, phone number verification, medical record requests and verbal call out approval notifications. • Provides administrative support of post service claims utilizing the member’s benefit contract and health plan guidelines. • Performs administrative tasks and work as directed by clinician or Team Lead/Operations.? Consults clinician and Team Lead/Operations Manager timely and appropriately. • Reports inventory numbers and assigns task lists under the direction of the Team Lead/Operations and as requested by the customer. • Prioritizes follow-up and actions based on case request receipt dates, customer workflow, service level agreements and regulatory timeframes. • Responsibilities exclude collection of non-scripted information, evaluation, or interpretation of clinical information, and providing medical advice/opinion on treatment or services. OTHERS: Project Shift Schedule: Night Shift Project Rest Day: Weekends Off Project/Team Location: Quezon City, Gateway Tower 2 SKILLS AND QUALIFICATIONS: • Holds a current and unrestricted Philippines Registered Nurse license. • At least 3 months of clinical experience, which can include internships or volunteer work, not necessarily only in hospitals. • Work experience should be as a registered nurse and not from before obtaining the license or taking the board exam. Good to have only: • Prior experience in healthcare setting/environment such as Utilization Management, Intake Representative, Health Insurance Claims Processor or Health Outreach Specialist is highly preferred. About Accenture Accenture is a leading global professional services company that helps the world’s leading businesses, governments and other organizations build their digital core, optimize their operations, accelerate revenue growth and enhance citizen services—creating tangible value at speed and scale. 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