HES Clinical Advocate
MedRisk Philippines
Mandaluyong, NCR, Philippines
2d ago

Position Summary

As an extension of the sales and account management teams, a MedRisk HES Customer / Clinical Advocate is responsible for managing and overseeing the treatment process by offering superior customer service and ease of use for referring clients.

The Advocate directs continued authorization and clinical communication between the provider and the referring customer while accommodating HES client-specific workflows and requests.

The Advocates objective is to manage each case with strict attention to timelines, relationship building and maintaining customer satisfaction regarding both treatment compliance and continued authorization management.

Proactive supervision of a case is a critical component of MedRisks position as the nations leading Physical Medicine Management Company.

A HES Customer Advocate works on behalf of referring clients to effectively control physical medicine costs by managing utilization.

Referring adjusters and nurse case managers rely on the Advocate to review and analyze provider clinical notes as well as monitor patient progress to ensure the case is within MedRisk clinical guidelines and / or following the adjusters specific direction.

Essential Responsibilities & Duties :

  • Manage multiple claims at one time from a compliance and clinical perspective
  • Manage a report of case status updates, continued authorization requests, approvals and range of motion update tasks within strict timelines
  • Obtain and review all treatment documentation per case
  • Review clinical documentation to ensure the patients treatment is on course and the case is within MedRisk clinical guidelines and / or following the adjusters specific direction
  • Properly transfer all case related data to MedRisks database, organize related documents efficiently and provide well-written documentation to ensure consistent communication across departments
  • Ensure that billing for corresponding treatments are processed in a timely fashion
  • Build approachable, professional relationship with referring customers to encourage repeat business
  • Effectively work with specific claims offices to ensure they are receiving the appropriate level of service in compliance with our turnaround times and objectives
  • Research and comply with client specific workflows, become familiar with the clients unique needs and respond appropriately
  • Effectively document any changes to client specific workflows to ensure the process is managed correctly

  • Must possess a college degree in any field (Nursing / PT / OT degree is a plus)
  • Must have experience in BPO industry
  • Impeccable customer service skills, preferably with 1-2 years of experience
  • Experience with outbound calls preferred
  • Ability to multitask in a fast-paced environment
  • Detail orientated
  • Excellent verbal and written communication skills
  • Proficient in MS Outlook, Word and Excel and general computer literacy, working with dual screens
  • Time management and strong organizational skills required
  • Willing to work onsite in Mandaluyong
  • Willing to work on night shift
  • Preferably residing within Metro Manila only. Candidates in Cavite, Rizal, and Bulacan area are welcome to apply as long as they are amenable to report onsite in Rockwell Business Center Sheridan - South Tower, Sheridan St., Mandaluyong City

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