DE033824-Health Operations Analyst

Accenture in the Philippines; Taguig; On-site; PHP 279,000 - 446,000; Full time

Job summary

Accenture in the Philippines seeks a Health Operations Analyst to support health services with night shift hours from Taguig Uptown Bonifacio Tower 3. You will handle calls, e-Reviews, and data entry, verify eligibility and benefits, and coordinate with clinicians for prior authorizations.

Applicants must hold a Philippine RN license and have at least 3 months of clinical experience, ideally within healthcare operations or utilization management. On-site role with return-to-office setup.

Qualifications

• 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 or Health Insurance is a plus.

Responsibilities

• Manages incoming/outgoing calls, e-Reviews, and/or faxes with data entry into client system.
• Verifies eligibility and benefits and determines contract terms.
• Performs provider radius search and follows up on referrals.
• Check benefits for facility-based treatment and obtain intake information.
• Process requests for pre-certification and/or prior authorization using scripts.
• Enter data into client systems and route as appropriate.
• Match fax/clinical records with the correct case and consolidate inputs for approval.
• Generate letters as directed by the client and manage workflow in the system.
• Refer cases requiring clinical review to a nurse reviewer and ensure accuracy.
• Assign cases to the correct queue and conduct outbound calls for additional clinical information.

Skills

Data entry

Telephone handling

Clinical experience

RN license

Prior Authorization

Provider outreach

Education

Registered Nurse license (PH)

Job description

Health Operations 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 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:

• 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
• 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.