This position will provide clinical support in a non-hospital setting, assisting in various healthcare-related services such as medical review, claims processing, utilization management, or telehealth support for clients in the US or other international locations.
Responsibilities:
- Review medical records and clinical documentation for accuracy, completeness, and compliance.
- Assist in the processing of health insurance claims, ensuring alignment with clinical standards and payer guidelines.
- Provide clinical input in utilization management, pre-authorization, or appeals processes.
- Conduct outbound and/or receive inbound calls related to patient care, benefits verification, or prior authorization.
Requirements:
- Active PRC License
- At least 1 year of hospital/clinical experience
- Previous BPO healthcare experience is a plus
- Excellent communication skills, both verbal and written
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