PHRN Team Lead (McKinley West Taguig) | Hybrid

Work Setup: Amenable to work onsite during training (2-3 months), Hybrid work arrangement after training 

Location: McKinley West, Taguig

Shift: Night Shift

Schedule: Weekends Off

Nature of Work: Voice

Requirements:

• Nursing Degree
• Should have an active PHRN license
• Must have experience handling a team for a minimum of 2 years in medical/clinical account (Global Support)
• Metrics/KPIs: Preferably with experience handling/monitoring metrics, e.g., CSAT, NPS, AHT, FCR

Key Responsibilities

• Clinical Review: Evaluate medical records, clinical notes, and treatment plans for medical necessity, often using tools like MCG or InterQual.
• Utilization Management: Analyze, claims, to ensure cost-effective care and adherence to, insurance policies.
• Documentation & Coding: Maintain accurate, professional, medical records and, documentation.
• Communication: Coordinate with, U.S. providers and, insurance representatives regarding, coverage and denials.
• Patient Support: Assist, patients with, inquiries regarding, benefits and, claim status. 

#TASQCorp

• HMO with up to 3 dependents covered
• Retirement Benefit
• Annual Appraisal
• Performance Bonus