Health Clinical Services Representative, L10
Location: Austin, TX
Accenture is a leading global professional services company that helps the world’s leading businesses, governments and other organizations build their digital core, optimize their operations, accelerate revenue growth and enhance citizen services—creating tangible value at speed and scale. We are a talent and innovation led company with 738,000 people serving clients in more than 120 countries.
Technology is at the core of change today, and we are one of the world’s leaders in helping drive that change, with strong ecosystem relationships. We combine our strength in technology with unmatched industry experience, functional expertise and global delivery capability. We are uniquely able to deliver tangible outcomes because of our broad range of services, solutions and assets across Strategy & Consulting, Technology, Operations, Industry X and Accenture Song. These capabilities, together with our culture of shared success and commitment to creating 360° value, enable us to help our clients succeed and build trusted, lasting relationships. We measure our success by the 360° value we create for our clients, each other, our shareholders, partners, and communities.
The Health Clinical Services Representative applies clinical background and expertise to enable services across the care continuum, targeted at consumer and provider engagement.
Key Responsibilities:
Provides reliable communication of critical patient information and data.
Manages and advise on clinical documentation and enhance member and provider experience and efficiencies.
Reviews and analyze medical necessity documentation and assessments according to established criteria and protocols.
Produces decisions as required based on knowledge of Medicaid requirements and training as a Registered Nurse.
Maintains appropriate documentation and support for all requests.
Ensure medically appropriate, high-quality, cost-effective care through assessing the medical necessity of outpatient services, out of network services, and appropriateness of treatment setting within the scope of professional limitations.
Manages incoming phone calls from the provider and customer communities.
Cross trains to other areas and assist as required.