Clinical Account Specialist - Nursing Graduates

Neolytix; Quezon City; On-site; PHP 446,000 - 781,000; Full time

Job summary

Neolytix is seeking a remote, full-time clinical-operations professional with a nursing degree and healthcare BPO experience. You will work a fixed night schedule (9 PM–6 AM PHT) from home, reviewing documentation and managing high-volume queues across multiple systems.

You will apply clinical judgment to prior authorizations, coordinate with physicians, and ensure HIPAA compliance while meeting productivity targets. This role leverages clinical training in a flexible remote setting.

Qualifications

• Review clinical documentation and chart notes for completeness, medical necessity, and accuracy in support of authorization and utilization review.
• Apply clinical judgment to prior authorization and precertification requests within established criteria.
• Nursing degree and healthcare BPO experience required.

Responsibilities

• Review clinical documentation and chart notes for completeness, medical necessity, and accuracy in support of authorization, utilization review, or documentation workflows
• Apply clinical judgment to prior authorization, precertification, or utilization review requests, working within established clinical and payer review criteria
• Navigate high-volume queues and multiple systems (EHR/EMR, payer portals, case management tools) while meeting daily productivity targets
• Document findings, decisions, and communications accurately, keeping audit-ready records
• Coordinate with physicians, nurses and clinical staff on cases needing additional information or peer-to-peer review
• Escalate complex or time-sensitive cases and track them to resolution
• Maintain HIPAA compliance and payer requirements along with internal quality standards
• Nursing degree and healthcare BPO experience required.

Skills

Clinical operations

Nursing background

Documentation

HIPAA compliance

Education

Bachelor's degree in Nursing

Tools

EHR/EMR systems

Payer portals

Case management tools

Job description

REMOTE (WFH) | FULL-TIME | 9PM-6AM PHT (FIXED SCHEDULE)

Neolytix is specifically looking for people who've already done hybrid clinical-operations work and been both things at once: have completed a nursing degree, and who also knows how to work on queues, productivity targets, multiple systems, and service-level expectations.

WHAT YOU WILL DO:

• Review clinical documentation and chart notes for completeness, medical necessity, and accuracy in support of authorization, utilization review, or documentation workflows
• Apply clinical judgment to prior authorization, precertification, or utilization review requests, working within established clinical and payer review criteria
• Navigate structured, high-volume queues and multiple systems - EHR/EMR, payer portals, and case management or workflow tools - while meeting daily productivity and turnaround expectations
• Document findings, decisions, and communications completely and accurately, keeping records audit-ready
• Coordinate with physicians, nurses, and other clinical staff on cases that need additional information or a peer-to-peer review
• Escalate complex or time-sensitive cases appropriately and track them through to resolution
• Maintain compliance with HIPAA, payer requirements, and internal quality standards
• Required: A completed nursing degree, combined with healthcare BPO experience

WHY APPLY?

This role allows you to do work that actually uses your clinical training! If you've done clinical work inside a structured, queue-driven operations environment before, you got what we need!