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Job Responsibilities:

  • Consults with medical and treatment staff regarding client diagNosis, medical justification, length of treatment, and case documentation.
  • Communicate with physicians to ascertain their plans for a timely discharge.
  • Handle inbound and outbound calls from patients and healthcare providers.
  • Analyze and determine the eligibility of medical claims
    Coordinate with providers and specialists in assessing the validity of claims.
  • Inform patients of the result of the validation of claims.

Qualifications:

  • Active US License
  • Active PRC license
  • With at least 1-year bedside experience
  • 6 months to 2 years of Utilization Review / Utilization Management experience
  • 1 year clinical exp, experience in BPO setting is required, Pioneer account