PHRN Associate

This position will provide clinical support in a non-hospital setting, assisting in various healthcare-related services such as medical review, claims processing, utilization management, or telehealth support for clients in the US or other international locations.

Responsibilities :

• Review medical records and clinical documentation for accuracy, completeness, and compliance.
• Assist in the processing of health insurance claims, ensuring alignment with clinical standards and payer guidelines.
• Provide clinical input in utilization management, pre-authorization, or appeals processes.
• Conduct outbound and / or receive inbound calls related to patient care, benefits verification, or prior authorization.

Requirements :