ABOUT THE ROLEWe are actively hiring experienced Medical Records Executives for our growing US Healthcare Voice Process team, supporting one of the USA's leading Electronic Health Record (EHR) platforms eClinicalWorks. This role combines medical records review with direct outbound patient calls for follow-ups, scheduling, and care coordination.If you have a robust eye for detail, a passion for US healthcare operations, and are comfortable with both medical records work and patient interaction in a night-shift environment this role is built for you.

KEY RESPONSIBILITIESCORE Medical Records ReviewMedical Records Audit & Documentation

- Review and audit patient medical records in eClinicalWorks for accuracy, completeness, and compliance before any outbound action is initiated
- Ensure all documentation in eClinicalWorks is accurate, complete, and HIPAA-compliant before and after every patient interaction
- Update patient records in real time with call outcomes, appointment details, Rx status, and DI order progress
- Maintain high data entry accuracy across all case types inaccurate records are a key quality metric
- Identify scheduling gaps, care follow-up needs, and open action items from records review and queue them for outbound contact

TCM Transitional Care Management

- Identify patients recently discharged from hospital or facility settings who qualify for Transitional Care Management services
- Initiate and document TCM contacts within the required CMS timeframes (2-business-day interactive contact and 7-day follow-up)
- Verify that the treating provider has completed the required face-to-face visit within 7 or 14 days as applicable
- Update TCM case status in eClinicalWorks with contact attempts, outcomes, and escalation flags
- Coordinate with the clinical team to ensure billable TCM encounters are captured and coded correctly
- Flag patients who cannot be reached within the compliance window and escalate per protocol

TCM Care Management

- Manage ongoing care coordination for high-risk and complex patients enrolled in TCM care management programs
- Conduct scheduled outreach calls to monitor patient adherence to post-discharge treatment plans, medications, and follow-up appointments
- Document care management interactions, patient-reported symptoms, and compliance barriers in eClinicalWorks
- Collaborate with the clinical care team to review patient progress and flag deterioration or non-compliance
- Track open care management tasks and ensure timely resolution within defined SLAs
- Maintain accurate records of patient enrollment status, program milestones, and care plan updates

Medication Reconciliation (Med-Reconciliation)

- Review and reconcile patient medication lists in eClinicalWorks against current prescriptions, pharmacy records, and provider notes
- Identify discrepancies such as duplicate medications, dosage mismatches, discontinued drugs still listed as active, or missing post-discharge prescriptions
- Flag reconciliation gaps to the clinical or pharmacy team for review and resolution
- Update the reconciled medication list in eClinicalWorks upon clinical confirmation
- Document all reconciliation activities with date, reviewer, and resolution outcome
- Ensure med-reconciliation is completed as part of the TCM workflow for all qualifying discharges

Refills Management

- Review the refill request queue in eClinicalWorks and process eligible refill requests within defined SLA windows
- Verify patient eligibility, insurance coverage, and last fill date before initiating a refill
- Confirm prescribing provider authorization for refills that require clinical sign-off
- Communicate refill status to patients via outbound calls or portal messages as required
- Identify and flag refill requests that require prior authorization and route them to the auth team
- Document all refill actions approved, denied, pending, or escalated with complete notes in eClinicalWorks

Failed Rx Follow-Up

- Identify and work failed Rx (prescription) cases — verify medication name, prescribing provider, failure reason (prior auth, NDC mismatch, eligibility lapse) and log findings
- Make outbound calls to patients regarding failed or unprocessed prescriptions identified during records review
- Communicate Rx failure status clearly and empathetically — guide patients on next steps and resolution timelines
- Escalate unresolved Rx cases to the clinical team or pharmacist queue within defined SLA — no case left open without a documented next action

Open Diagnostic Imaging (DI) Review

- Review open Diagnostic Imaging (DI) orders — flag aging orders, verify pre-authorisation status, and prepare case notes for outbound follow-up
- Contact patients with open DI orders — confirm awareness and assist with imaging facility scheduling
- Do not confirm any DI appointment without first verifying insurance pre-authorisation clearance
- Update DI order status in eClinicalWorks with appointment date, facility, and confirmation details

Open Labs

- Review outstanding lab order queues in eClinicalWorks to identify patients with pending or unreturned lab results
- Contact patients with open lab orders to confirm specimen collection status and assist with scheduling lab visits if not yet completed
- Follow up with reference labs or internal lab teams on delayed or missing results that are impacting patient care timelines
- Notify the treating provider of significantly delayed or abnormal results per escalation protocol
- Document all lab follow-up activities in eClinicalWorks with date, outcome, and any required next steps
- Track open lab cases to closure and update status in the schedule tracker as applicable

Prior Authorization

- Review and initiate prior authorization requests for medications, procedures, and diagnostic imaging orders in eClinicalWorks
- Verify insurance plan requirements, clinical documentation, and provider attestation before submitting auth requests
- Track submitted prior auth cases and follow up with insurance carriers on pending or delayed decisions
- Update auth status in eClinicalWorks and notify the clinical team upon approval, denial, or peer-to-peer review requirement
- Document all prior auth activities with payer reference numbers, dates, and outcomes
- Escalate denials to the clinical or billing team for appeal initiation within defined timelines

Fibroscan Without Order

- Identify patients in eClinicalWorks who have undergone or are scheduled for a Fibroscan procedure without a corresponding provider order on file
- Contact the ordering or treating provider's office to obtain and attach the missing order to the patient record
- Outreach patients as needed to clarify scan history and confirm procedure details for accurate documentation
- Update the patient record in eClinicalWorks once the order is secured, linking it correctly to the procedure encounter
- Escalate cases where an order cannot be obtained to the compliance or clinical documentation team
- Maintain a tracking log of Fibroscan-without-order cases from identification through resolution

Autoposting / P2P (Posting & Peer-to-Peer)

- Process automated posting of insurance payments, EOBs (Explanation of Benefits), and remittance data in eClinicalWorks
- Identify and resolve posting exceptions — mismatched claim IDs, zero-pay EOBs, and unapplied credits — escalating to the billing team as required




- Coordinate peer-to-peer (P2P) review scheduling between the provider and insurance medical director for denied or pending clinical authorizations
- Document P2P review outcomes in eClinicalWorks and update claim or auth status accordingly
- Maintain an autoposting exception log and ensure all unresolved items are actioned within defined SLA

VOICE — Patient Outbound CallsIncoming Calls

- Receive and manage inbound patient calls directed to the care coordination queue
- Perform two-factor identity verification on every inbound call before discussing clinical, scheduling, or Rx information
- Address patient queries related to appointments, prescriptions, lab results, referrals, and billing inquiries per defined call scripts
- Route calls that require clinical guidance to the appropriate provider or nurse queue — do not provide clinical advice outside approved scripts
- Document all inbound call outcomes in eClinicalWorks in real time, including patient concern, action taken, and follow-up required
- Log all incoming call dispositions accurately — blank or 'unknown' dispositions are not accepted

Patient Appointment Scheduling

- Schedule patient appointments with US-based healthcare providers via outbound calls
- Conduct two-factor patient identity verification before any scheduling or clinical discussion
- Confirm insurance eligibility, preferred provider, and offer a minimum of two available time slots per call
- Enter all appointment details in eClinicalWorks in real time during the call
- Confirm appointment verbally and provide the patient with a callback number for follow-up queries

Called and Verified – Patient Booked Appointment Online (Templates)

- Review the eClinicalWorks appointment queue for patients who have self-scheduled appointments via the online patient portal
- Make outbound calls to verify the appointment details and confirm the patient's intent, correct provider, and appropriate appointment type
- Use approved call templates and scripts for portal booking verification — do not deviate from the approved template flow
- Identify and correct booking errors (wrong provider, wrong location, incorrect appointment type) in real time during the verification call
- Update the appointment record in eClinicalWorks with verification status and call outcome
- Flag unverifiable portal bookings for supervisor review — do not leave unconfirmed appointments without a documented status

Booked an Online Appointment Through Portal – ADS & ECW Sync Check

- Periodically book test appointments via the patient portal to verify that appointment data is syncing correctly between the portal, ADS (Appointment Distribution System), and eClinicalWorks
- Confirm that appointment details — provider, date, time, location, and appointment type — are reflected accurately and consistently across all three platforms
- Document any sync discrepancies or data mismatches and report them to the IT or systems team for resolution
- Maintain a log of sync verification tests with test date, appointment ID, platforms checked, and outcome (pass/fail)
- Escalate recurring or unresolved sync failures to the supervisor and IT team within defined SLA

Telephone Encounters (Tel Encounters)

- Create and manage telephone encounter records in eClinicalWorks for all patient calls that involve a clinical discussion, care coordination action, or provider message relay
- Accurately document the nature of the call, patient concerns, provider instructions, and follow-up actions within the tel encounter template
- Route tel encounters requiring provider review or response to the appropriate clinical queue within defined turnaround times
- Follow up on open tel encounters to ensure provider responses are communicated back to the patient within SLA
- Ensure all tel encounters are signed off and closed appropriately — open or undispositioned tel encounters are a quality flag

Reminder Text Messages – Checked and Called to Confirm Cancellation

- Monitor automated appointment reminder responses — review all patient replies indicating cancellation intent received via text or portal
- Make outbound calls to patients who have responded with cancellation requests to confirm intent and redirect to rescheduling per the no-cancellation-without-reschedule protocol
- Document each reminder response review and associated call outcome in eClinicalWorks
- Escalate patients who decline rescheduling to the Care Coordination team for follow-up
- Track and report daily reminder response volumes and cancellation conversion rates

No Cancellation Call Policy

- Agents are not authorised to process appointment cancellations without supervisor approval
- When a patient requests cancellation, redirect immediately to the rescheduling workflow and offer the next available slot
- Document all cancellation attempts with reason, patient response, and final disposition for quality review
- Escalate repeat cancellation requests to the Care Coordination team

Urgent Bot – Failed Appointment

- Monitor the Urgent Bot alert queue in eClinicalWorks for patients flagged with failed or missed appointment triggers
- Triage urgent bot alerts by priority level — same-day missed appointments and high-risk patient flags are actioned first
- Make immediate outbound calls to patients with failed appointment alerts to reschedule within the same business day where possible
- Document all urgent bot alert outcomes in eClinicalWorks — no alert should be left open without a disposition
- Escalate patients who cannot be reached after defined contact attempts to the supervisor and Care Coordination team
- Track urgent bot alert resolution rates as part of daily quality metrics

Patient Concerns

- Receive and document patient concerns raised during inbound or outbound calls — including complaints, dissatisfaction, or unresolved care issues
- Handle patient concerns with empathy and professionalism — acknowledge the concern, clarify the issue, and communicate next steps clearly
- Route clinical concerns to the nurse or provider queue immediately — do not attempt to resolve clinical issues outside of approved scope
- Document all patient concerns in eClinicalWorks with full detail: concern type, patient statement, action taken, and escalation path
- Follow up on open patient concerns within the defined SLA and confirm resolution with the patient where required
- Escalate unresolved or high-severity patient concerns to the supervisor and Care Coordination team without delay

Voicemail Management

- Review the voicemail queue at the start of each shift and at defined intervals throughout the shift
- Return all patient voicemails within the defined SLA — same-day callback required for messages received during business hours
- Document voicemail details and callback outcomes in eClinicalWorks — include message summary, callback date/time, and result
- Prioritise voicemails flagged as urgent, clinical,



or related to prescription or appointment failures
- Escalate voicemails that require clinical response to the appropriate provider or nurse queue
- Ensure no voicemail is left unreturned without a documented reason and supervisor awareness

Vatica / Stellar Patients

- Manage outreach and records coordination for patients enrolled in Vatica Health and Stellar Health value-based care programs
- Review Vatica and Stellar patient lists in eClinicalWorks and identify patients with open care gaps, pending annual wellness visits, or unaddressed quality measures
- Make outbound calls to Vatica / Stellar-attributed patients to schedule required visits, close care gaps, and confirm program participation
- Document all Vatica and Stellar patient interactions in eClinicalWorks with program-specific notes and outcomes
- Coordinate with the clinical team to ensure completed care gap closures are coded and submitted to Vatica or Stellar within required reporting timelines
- Track Vatica and Stellar patient engagement rates and report on care gap closure progress as part of daily performance metrics

Temple Initiation

- Identify patients who are eligible for or require initiation into the Temple Health network program based on provider referral or care management flags in eClinicalWorks
- Make outbound calls to eligible patients to explain the Temple program, confirm interest, and initiate the enrolment or referral process
- Collect and verify required patient information for Temple programme initiation and document it accurately in eClinicalWorks
- Coordinate with the Temple Health liaison or internal referral team to ensure intake paperwork and referrals are submitted correctly
- Follow up with patients on the status of their Temple initiation and confirm programme enrolment completion
- Document all Temple initiation activities with status, next steps, and outcome in eClinicalWorks

PERFORMANCE — Incentive & Compliance Measures

- Incentive targets are tracked monthly across: records accuracy, Rx resolution rate, scheduling conversion rate, and call quality scores
- Eligibility requires consistent HIPAA compliance, adherence to call scripts, and zero unapproved dispositions
- Improvised clinical guidance outside approved scripts is strictly prohibited
- Bonus disqualifiers: inaccurate documentation, skipped verification steps, or policy violations

Incentives

- Monthly incentive payouts are calculated based on a composite performance score across all tracked workstreams
- Tracked metrics include: records review accuracy, refill processing rate, Rx resolution TAT, scheduling conversion, call quality score, and TCM/care management task completion rate
- Agents must meet minimum threshold scores in all tracked categories to qualify for the monthly incentive payout — partial thresholds do not qualify
- HIPAA compliance, script adherence, and documentation completeness are mandatory baseline requirements — violations in these areas result in full incentive disqualification for that month
- Top performers across key metrics are eligible for additional performance bonuses and fast-track progression recognition
- Incentive scores are reviewed with each agent in the monthly performance review session — all scores are documented and communicated transparently

Disaster Huddle QA Count

- Participate in scheduled Disaster Huddle QA sessions — structured quality review meetings held to assess call handling, documentation accuracy, and process adherence during high-volume or system disruption periods
- Review sampled call recordings and eClinicalWorks documentation entries during QA huddles and identify deviations from approved call scripts, verification protocols, or documentation standards
- Document QA huddle findings accurately — including call ID, agent, error type, severity, and corrective action required
- Apply QA huddle feedback immediately to active workflows — recurring errors identified in huddles are tracked and monitored for resolution
- QA huddle participation and scores are factored into the monthly performance review and incentive calculation
- Agents are expected to acknowledge QA findings, complete any required refresher training, and demonstrate improvement in subsequent QA reviews

Schedule Tracker

- Maintain and update the Schedule Tracker daily — a centralised log used to monitor the status of all open patient appointments, follow-up actions, lab orders, DI orders, TCM contacts, and care management tasks
- Record all new appointments, reschedules, cancellations, and failed contacts in the Schedule Tracker in real time
- Cross-reference the Schedule Tracker with eClinicalWorks to ensure alignment — discrepancies between the two must be flagged and resolved on the same business day
- Use the Schedule Tracker to prioritise daily workload — aging open items, same-day urgent flags, and SLA-approaching tasks are worked first
- Submit a daily Schedule Tracker update to the supervisor at end of shift — including total items worked, items closed, items pending, and any escalation flags
- The Schedule Tracker is a key performance and audit tool — incomplete or inaccurate entries are treated as documentation errors

REQUIRED SKILLS & QUALIFICATIONS

- Minimum 1 year of experience in Medical Records / Healthcare BPO / International Voice Process
- Hands-on knowledge of eClinicalWorks EHR — mandatory; proficiency is a strong advantage
- Strong data entry accuracy and attention to detail — records work is the primary function of this role
- Familiarity with US healthcare workflows: Rx processing, prior authorisation, diagnostic imaging orders, appointment scheduling
- Thorough understanding of HIPAA regulations and patient data confidentiality requirements
- Good verbal communication in English — clear, professional, and empathetic phone manner for patient-facing calls
- Excellent organisational and time-management skills — able to manage multiple open cases simultaneously
- Ability to multitask effectively in a high-volume, fast-paced night-shift environment
- Working knowledge of medical terminology (preferred)
- 12th pass or any graduate; background in Healthcare / Customer Service preferred

WHY JOIN US?

- Reputed Healthcare BPO with a strong, established track record in the US market
- Meaningful work — every call directly impacts patient care and outcomes
- Competitive salary with attractive night shift allowance
- Structured career growth with clear progression paths in US healthcare operations
- Continuous learning environment — regular training, upskilling, and process coaching
- Supportive, team-oriented culture with experienced healthcare BPO leadership

GENERAL VOICE PROCESS STANDARDS

- Always verify patient identity (two-factor) before discussing any clinical, Rx, or scheduling information — HIPAA mandatory
- All calls must be dispositioned accurately — 'unknown' or blank outcomes are not accepted
- Wrap-up / ACW time is reserved exclusively for completing call documentation; not for initiating the next call
- Adhere to call scripts at all times — clinical advice outside approved scripts is strictly prohibited
- Night shift attendance and punctuality directly impact team SLA performance — adherence is tracked

HOW TO APPLY

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Don't miss this opportunity to build your career in the US healthcare space!Chennai, Tamil Nadu | Night Shift – 6:pm-2:30 am IST | eClinicalWorks EHR | HIPAA Compliant Process

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