The Role
Review and analyze medical records for completeness and relevance, develop clinical chronologies, communicate with providers, and manage documentation.
Summary Generated by Built In
- Review incoming medical records for completeness, relevance, and quality based on claim requirements
- Develop a clinical chronology by organizing records to reflect the progression of diagnosis and treatment
- Identify and differentiate diagnostic records from severity-related documentation
- Assess medical records for causation support and relevance to the claimed condition
- Detect gaps in clinical evidence (e.g., missing records, insufficient documentation, inconsistencies) and escalate with proper rationale
- Utilize OCR tools (e.g., Adobe Acrobat) to process scanned documents; flag illegible records for reprocessing
- Evaluate physician-issued severity letters to ensure alignment with required clinical standards
- Maintain accurate filing and documentation of records within internal systems
- Update system fields and ensure all relevant information is properly recorded
- Manage daily task queues and prioritize urgent or time-sensitive cases
- Communicate with medical providers or facilities when additional documentation is required
Requirements
- Okay to work the night shift/Graveyard schedule
- Willing to work on-site
- Licensed Nurse (RN) or equivalent clinical professional (Philippine license accepted; active license preferred)
- at least 6 months BPO experience (healthcare account experience is an advantage)
- Strong ability to read, interpret, and analyze medical records at a clinical level
- Experience in medical documentation, clinical review, or medicolegal records is preferred
- Excellent written communication skills with the ability to present clinical findings clearly and concisely
- Good verbal communication skills and willingness to coordinate with medical providers when needed
Skills Required
- Licensed Nurse (RN) or equivalent clinical professional
- 6 months BPO experience
- Experience in medical documentation or clinical review
- Strong ability to read and analyze medical records
- Excellent written communication skills
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The Company
What We Do
OP360 is a US-headquartered BPO provider offering intelligent customer experience and outsourcing solutions. They partner with ambitious global brands to make scaling easy, specializing in customer support, back-office operations, and AI services across diverse industries.
