We Love AI JobsDE033824-Health Operations Analyst
Accenture Federal ServicesYou will process healthcare service requests by gathering information, checking eligibility and benefits, and creating and routing cases. The role involves scripted communication with callers and providers, preparing records for clinical review, and working an office-based night shift in Taguig.
Skills & Expertise
Key Responsibilities
Handle calls, reviews, and faxes; gather information and create cases in client systems.
Verify eligibility and benefits, and follow up with providers on referrals and records.
Route cases accurately and prepare complete information for clinical review.
Full 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
Equal Employment Opportunity Statement
We believe that no one should be discriminated against because of their differences. All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, military veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by applicable law. Our rich diversity makes us more innovative, more competitive, and more creative, which helps us better serve our clients and our communities.