Clinical Account Specialist – Nursing Graduates

About the Role

This management service organization specializes in improving healthcare business performance through revenue optimization and cost reduction. With more than a decade of experience, the firm assists independent medical practices with medical billing, revenue cycle management, practice marketing, and remote patient monitoring. The mission is to boost monthly revenue, simplify administrative tasks, and elevate the patient experience, enabling physicians to prioritize clinical care. As a Clinical Account Specialist, you will act as a link between clinical tasks and administrative operations. You will be part of a team dedicated to providing expert support to healthcare providers by managing critical workflows and documentation. This remote role allows nursing professionals to utilize their clinical expertise in a corporate setting to drive the operational efficiency of medical practices.

Requirements

• You must have a nursing degree and previous experience in a healthcare BPO setting.
• You should be capable of balancing both clinical and administrative responsibilities.
• You need to demonstrate the ability to handle large workloads, navigate clinical workflows, and fulfill daily turnaround and productivity targets.
• You must be proficient with technology, specifically EHR/EMR platforms, payer portals, and workflow or case management software.
• You are required to apply sound clinical judgment for utilization reviews, prior authorizations, and medical necessity assessments.
• You must possess a solid understanding of HIPAA rules, internal quality protocols, and payer requirements, alongside prior experience within the U.S. healthcare landscape.

Responsibilities

• You will evaluate clinical charts and documentation to verify their accuracy, completeness, and adherence to medical necessity standards.
• You will facilitate authorization and utilization review processes by using your clinical knowledge to manage precertification and prior authorization requests.
• You will process high-volume queues across various clinical platforms while meeting established productivity and turnaround time goals.
• You will record all interactions, outcomes, and findings with high attention to detail.
• You will collaborate with physicians, nursing staff, and other clinical personnel to ensure cases are resolved.
• You will monitor complex or urgent matters until they are finalized and report them as needed.
• You will uphold full compliance with HIPAA regulations, payer guidelines, and internal quality procedures.