PHRN - Up to 47k monthly

Clinical Support / Triage

Provide clinical advice or information to patients, healthcare providers, or insurance clients (depending on the account).

Conduct symptom checks or guide patients on next steps using set clinical guidelines.

Utilization Review / Case Management

Review medical records to determine if hospital stays or procedures meet medical necessity.

Coordinate with U.S.-based nurses or physicians to ensure appropriate care and documentation.

Claims and Pre-Authorization

Evaluate insurance claims, prior authorization requests, or appeal cases based on clinical documentation.

Medical Documentation and Data Entry

Ensure accurate input of patient data, diagnoses, and treatment notes into electronic health records (EHRs).

Customer Service with Medical Knowledge

Handle calls from patients or healthcare professionals regarding benefits, authorizations, prescriptions, or billing—using both medical and customer service skills.

Compliance and Confidentiality

Follow HIPAA (Health Insurance Portability and Accountability Act) guidelines for patient data privacy.

Maintain professionalism and adhere to call quality and documentation standards.