Salary, Perks, and Benefits:
Job Responsibilities:
- Identifies solutions to Non-standard requests and problems
- Solves moderate to complex problems and does analysis with it, works with minimal guidance
- Translates clinical concepts into practice, and provides explanations and information for issues
- Analyse and determine the eligibility of medical claimsInform patients of the result of the validation of claimsPerform Utilization Management reviews in accordance with federal state-mandated regulations.
- Utilizes the member’s contract to determine coverage eligibility.
Qualifications:
- With an active US license (valid for at least 6 months)
- With an active PRC license (valid for at least 6 months)
- Must have at least 1 year of hospital/clinical experience
- Amenable to working on graveyard or shifting schedule