DE033824-Health Operations Analyst

Accenture PLC; Taguig; On-site; PHP 480,000 - 600,000; Full time

Job summary

Accenture is seeking a Health Operations Analyst in Taguig for night shift. You will manage calls, perform e-Reviews, and process non-clinical data while ensuring accurate case entry and routing in client systems.

Candidate must hold a Philippines RN license and have at least 3 months of clinical experience, possibly from internships or volunteer work, with preference for prior healthcare exposure. Return to Office setup in Uptown area.

Qualifications

• Current and unrestricted Philippines Registered Nurse license.
• At least 3 months of clinical experience, including internships or volunteer work.

Responsibilities

• Handle incoming/outgoing calls, e-Reviews, and faxes with accurate data entry.
• Verify eligibility and benefits and determine contract terms.
• Perform provider radius searches and follow up on referrals.
• Check facility-based treatment benefits and process intake information.
• Route cases and inputs in client systems; ensure accuracy for pre-certification.

Skills

Data entry

Triage

Phone handling

Clinical knowledge

Education

Philippines Registered Nurse license

Job description

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.

Equal Employment Opportunity Statement

All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.

Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process.

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