Health Admin Services Analyst

Health Admin Services Analyst

To provide support to the clinical team and client team to assist in the promotion of quality member outcomes, to optimize member benefits, and to promote effective use of resources. Supports the procedures that ensure adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective. Utilization Management: Gathers information using the appropriate client-specific telephonic screening tools. Conducts pre-review screening under the guidance and direction of US licensed health professionals. Case Management/Disease Management - Provides support functions for wellness programs, health management programs and preventative care opportunities that the member may have as part of their benefits. Gathers information using the appropriate client-specific telephonic screening tools.

• Written Communication

• Microsoft Excel

• Microsoft PowerPoint

• Requires analysis and solving of increasingly complex problems.

• Interaction is with peers within Accenture before updating supervisors. Likely has some interaction with clients and/or Accenture management.

• With proper guidance and oversight by Team Lead, may be tapped for precepting, training, mentoring and job shadowing duties.

• Individual contributor as a part of a team, with a predetermined, focused scope of work.

• Requires detailed to moderate level of instruction on daily work tasks and detailed instruction on new assignments.

• Decisions impact own work.

• Holds current and unrestricted local (PH) Registered Nurse license.

• Bachelor of Science Nursing (BSN) degree.

• Excellent written and verbal communication skills in English.

• Must pass American English and alternate language fluency test ("Test") upon hire (non-US resident) by successfully completing internal written test. For voice accounts, you must pass US Berlitz B2 level or Versant score 58 and above upon hire or upon assuming role.

• Proficiency in basic computer knowledge with the ability to learn additional computer programs.

• A minimum of three (3) months of prior working experience as a Registered Nurse in a clinical setting required o Three months is equivalent to 480 hours of working experience as an RN o Work experience as a Registered Nurse means holding an active RN license and providing direct patient care o Clinical setting includes inpatient hospital, outpatient hospital or clinic, or 1-year related Accenture or other outsourcing experience or returning Analyst employee.

• Strong customer service focus o Ability to empathize o Prioritizing customer needs o Listening, patience & action oriented Related outsourcing operations experience.

• Claims reviews/audit experience and data entry experience.

• 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 caller, e-Reviews, and/or from fax. 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 Match fax/clinical records with appropriate case.

• Consolidate inputs for approval.

• Generate the needed letters as directed by client and/or outlined in client’s procedure manual.

• Assign cases/activities and work within 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, correct, and "nurse ready".

• Tasks cases accurately to the correct queue.

• Conducts outbound scripted calls to providers to request clinical information as directed by clinician.

• Conducts outbound scripted calls to providers to complete approval notification process as directed by clinician.

• Performs Daily Task list maintenance activities under the direction of the Team Lead/Operations Manager and as per customer workflow.

• Provide administrative support to /Nurse Reviewer via case preparation, phone number verification, medical record requests and verbal call out approval notifications.

• Provide administrative support of post service claims utilizing the member’s benefit contract and health plan guidelines.

• Performs administrative tasks and work as directed by clinician or Team Lead/Operations. Consults clinician and Team Lead/Operations Manager timely and appropriately.

Any Graduation

Accenture is a leading global professional services company that helps the world's leading businesses, governments and other organizations build their digital core, optimize their operations, accelerate revenue growth and enhance citizen services—creating tangible value at speed and scale. We are a talent- and innovation-led company with approximately 791,000 people serving clients in more than 120 countries. Technology is at the core of change today, and we are one of the world’s leaders in helping drive that change, with strong ecosystem relationships. We combine our strength in technology and leadership in cloud, data and AI with unmatched industry experience, functional expertise and global delivery capability. Our broad range of services, solutions and assets across Strategy & Consulting, Technology, Operations, Industry X and Song, together with our culture of shared success and commitment to creating 360° value, enable us to help our clients reinvent and build trusted, lasting relationships. We measure our success by the 360° value we create for our clients, each other, our shareholders, partners and communities.