Key Responsibilities :

•Review and verify medical reports for accuracy
•Maintain and update documentation systems
•Handled communications with stakeholders
•Monitor compliance with healthcare regulations

Non-Negotiable Requirements:
• PH Registered Nurse
• Registered Nurse with current, unrestricted US Registered Nurse license w/ BPO Experience and QA Experience
• Minimum 2 years of clinical bedside experience (ER, ICU, Med-Surg, Telemetry preferred).
• Minimum 1 year of USRN BPO or U.S. Healthcare experience in UM, CM, Appeals, Triage, or related clinical processes.
• Knowledge of MCG/Milliman, InterQual, clinical guidelines, HIPAA requirements, and U.S. medical terminology.
• Prior experience as a Quality Analyst, Clinical Auditor, or Clinical Reviewer in a U.S. healthcare account.
• Strong analytical skills with high attention to detail and documentation accuracy.
• At least one (1) year of experience in medical account for clerical or administrative support; someone experienced in handling or reviewing medical data or documentation
• Excellent English communication skills both verbal and written; must be comfortable in taking phone calls and high-volume emails.
• Ability to stay focused and adaptable under pressure and shifting priorities
• Knowledgeable in US Healthcare Law and Care Coordination
• Familiarity with coding systems (ICD-10, CPT) is a plus.
• Strong proficiency in MS Office tools and QA evaluation systems."