DE033824-Health Operations Analyst

Accenture in the Philippines; Taguig; On-site; PHP 360,000 - 540,000; Full time

Benefits offered by this job

Health insurance

Job summary

Accenture in the Philippines is hiring a Health Operations Analyst for a night shift based in Taguig Uptown Bonifacio Tower 3. You will manage calls, e-Reviews, and referrals, confirm eligibility/benefits, and assist with pre-certification and prior authorization processes.

Requires a current Philippines RN license and at least 3 months of clinical experience. This Return to Office role expects strict data entry, accurate case routing, and collaboration with clinicians to ensure efficient

Qualifications

• Must hold a current and unrestricted Philippines Registered Nurse license.
• Minimum 3 months of clinical experience, including internships or volunteer work.
• Experience in Utilization Management, Intake, Health Insurance Claims, or Health Outreach is preferred.

Responsibilities

• Manage calls, e-Reviews, and faxes with case opening and data entry.
• Verify eligibility and benefits, and conduct provider radius searches.
• Obtain intake information and process requests for pre-certification and/or prior authorization.
• Enter data into client systems and route appropriately.
• Coordinate referrals and keep clinicians informed.
• Shift Schedule: Night Shift; Weekends Off; Location: Taguig Uptown Bonifacio Tower 3.

Skills

RN license

Education

Philippines RN license

Job description

Job Eligibility

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.
• 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.