DE033824-Health Operations Analyst

8003 Accenture Inc Company; Taguig; On-site; PHP 300,000 - 420,000; Full time

Job summary

Accenture is hiring a Health Operations Analyst in Taguig (Return to Office). The role requires a current Philippines RN license and at least 3 months of clinical experience, including internships or volunteer work. Prior exposure to Utilization Management or health insurance processes is preferred.

Responsibilities include triaging calls, verifying benefits, data entry, and coordinating with clinicians to ensure accurate case processing. Night shift schedule applies, with weekends off as needed.

Qualifications

• Must hold a current Philippines Registered Nurse license.
• At least 3 months of clinical experience, including internships or volunteer work.
• Experience in healthcare settings such as Utilization Management, Intake, Health Insurance Claims is preferred.

Responsibilities

• Manages calls, e-Reviews, and faxes with data entry into client system.
• Verifies eligibility and benefits; conducts provider radius searches.
• Obtains intake information from callers and processes requests for pre-certification or prior authorization.
• Performs data entry and routes cases; assigns cases to queues to support workflow.
• Refers clinical review cases to nurse reviewer; conducts case checks for accuracy.
• Makes outbound scripted calls to providers to obtain clinical information as directed.

Skills

RN license

Clinical experience

Healthcare background

Education

Nursing degree or diploma

Job description

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 Operations Analyst

WORK SETUP: Return to Office

RESPONSIBILITIES:

• Manages incoming or outgoing telephone calls, e-Reviews, and/or faxes, including triage, opening of cases and data entry into client system.
• 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.

OTHERS:

Project Shift Schedule: Night Shift

Project Rest Day: Weekends Off

Project/Team Location: Taguig Uptown Bonifacio Tower 3

SKILL 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. We are a talent- and innovation-led company with approximately 791,000 people serving clients in more than 120 countries. Technology is at the core of change today, and we are one of the world’s leaders in helping drive that change, with strong ecosystem relationships. We combine our strength in technology and leadership in cloud, data and AI with unmatched industry experience, functional expertise and global delivery capability. Our broad range of services, solutions and assets across Strategy & Consulting, Technology, Operations, Industry X and Song, together with our culture of shared success and commitment to creating 360° value, enable us to help our clients reinvent and build trusted, lasting relationships. We measure our success by the 360° value we create for our clients, each other, our shareholders, partners and communities. Visit us at www.accenture.com

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