DE033824-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: • 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.

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