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