Position Summary:
Responsible for coordinating the execution and continued quality of the client's Utilization Review Department Process - performs assigned duties including telephonic online authorization of routine services, contacting speciality care providers, monitoring patient eligibility, and performing online data entry of routine authorizations/denials.
Role & Responsibilities:
A Philippine Registered Nurse (PRN) may be tasked to do any of the following:
- Bill Review
- Claims Assistant / Claims Support Specialist
- Client Service Representative
- Clinical Abstractor
- Clinical Data Coordinator
- Clinical Support Specialist
- Demand Package Solutions Nurse Review
- Intake Specialist
- Medical Coder
- Quality Reviewer
- Medical Coordinator
- Nurse Review
- Panel Card
- Physician Review Prep Nurse
- Physician Review Service Coordinator
- Pre-Authorization Representative
- Quality and Training
Essential Knowledge and Skills Required:
- Ability to use PC and widely-used software packages, especially Microsoft Office handling of
- Spreadsheets and word processing
- Type minimum of 33 wpm with excellent accuracy
- Excellent verbal and written communication skills in English
- Ability to perform effectively in a fast-paced environment
- Ability to be detail-oriented and be able to work independently