Clinical Support Specialist

7 days ago


Pasig, National Capital Region, Philippines Manpower Core Group Inc. Full time
Job Overview
At Manpower Core Group Inc., we offer a challenging opportunity for an experienced professional to join our medical claims team.

We are seeking a highly skilled Clinical Support Specialist to provide critical support to our clinical team and clients. The successful candidate will be responsible for determining customer eligibility, assessing medical appropriateness of claims, and ensuring accurate and timely payment of covered claims.

Key Responsibilities
• Provide support to the clinical team and client team
• Determine customer eligibility by reviewing contractual language and medical documentation
• Assess medical appropriateness of claims submitted, and adjust claims as needed
• Pay all covered claims accurately and timely
• Manage both new claims and open claims equally and maintain decision turnaround times

Required Skills and Qualifications
• Active license
• At least 6 months Hospital experience
• 1 year prior authorization experience – negotiable: Healthcare experience
• Handling payer side/ provider side/ handling scheduling or any inbound process
• Good typing skills
• Scope of work inbound or outbound calls or pre-reg- patients that are scheduled outpatient imaging, update insurance, provide prep/ patient instructions

Additional Information
This position will be working with the world's largest medical coding staff. Working Set-up: Onsite. Mondays to Fridays. Complete details will provide by our Recruiters.

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