DE033651-Health Clinical Services Senior 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 Clinical Services Senior Analyst WORK SETUP: Return to Office RESPONSIBILITIES:
• Bachelor of Science Nursing (BSN) degree or General Nursing & Midwifery (GNM) Diploma or Basic Bachelor of Science (BSC) in Nursing degree or Associate Nursing Degree or Nursing Diploma
• Three months prior clinical experience, this is equivalent to 480 hours of working experience as an RN
• Working experience as a Registered Nurse means holding an active RN license and providing direct patient care
• Clinical settings include inpatient hospital, outpatient hospital or community clinic (excluding hotel nurse, school, airport, transport, or company nurse. Requires copy of JD from employer and requires internal CVE (clearance via exception).
• Holds current and unrestricted US Registered Nurse license; holds state specific RN licensure as required.
• Excellent written and verbal communication skills in English.
• For voice accounts, must pass US Berlitz B2 level or Versant score of 58 or any language proficiency equivalence.
• Proficiency in basic computer knowledge with the ability to learn additional computer programs.
• 6 months’ prior BPO experience or a minimum of 6 months’ prior working experience as a Registered Nurse in a clinical setting.
• Strong customer service focus
• Ability to empathize
• Prioritizing customer needs
• Listening, patience & action oriented
• Good understanding of phone etiquette
• Knowledge of ICD-9 and ICD-10 and CPT codes
• Experience in medical or insurance field
• PSCCR associates: Claim reviews/audit experience
• 3 Months UM experience OTHERS: Project Shift Schedule: Rotation Project Rest Day: Rotation Project/Team Location: Taguig Uptown Bonifacio Tower 3

SKILL AND QUALIFICATIONS

• Bachelor of Science Nursing (BSN) degree or General Nursing & Midwifery (GNM) Diploma or Basic Bachelor of Science (BSC) in Nursing degree or Associate Nursing Degree or Nursing Diploma
• Holds current and unrestricted US Registered Nurse license
• 3 months clinical experience (480 hours of working experience as a RN)
• Work experience as an active RN license and providing direct patient care
• Clinical setting includes inpatient hospital, outpatient hospital or community clinic
• No state license required (doability will be revisited if there's a specific state of RN license needed)
• With at least 3-month UM experience

Flex

• Open to candidates (without UM experience) with Appeals experience