Clinical Account Specialist
Job Summary
Combining clinical expertise with operational efficiency, the full-time Clinical Account Specialist will review clinical documentation, apply clinical judgment to authorization requests, and navigate high-volume queues in a remote work environment.
Key responsibilities:
- Review clinical documentation for completeness and accuracy to support authorization and utilization review workflows
- Apply clinical judgment to prior authorization and utilization review requests while adhering to established criteria
- Document findings and coordinate with clinical staff on cases requiring additional information or peer reviews
Required qualifications:
- A completed nursing degree
- Experience in a healthcare BPO environment
- Familiarity with EHR/EMR systems and payer portals
- Understanding of HIPAA compliance and payer requirements
- Ability to work within structured, high-volume operational environments
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