Job Description:

Key Responsibilities
Responsible for reviewing and analyzing discrepancies by cross-verifying from different data sources
Familiar with US Healthcare domain knowledge and understanding of healthcare regulations (HIPAA)
Deep understanding of medical coding, billing, and medical terminologies
Operates with urgency in a real time service workplace
Defines, communicates and manages workflow and data coordination to support various implementation related reports (i.e., reporting, inventory, capacity reporting, and ad-hoc reports as needed by management)
Review and evaluate medical insurance claims and documents.
Analyze clinical information and medical reports for claim validation.
Ensure accurate processing of claims as per policy guidelines.
Maintain proper documentation and records.
Coordinate with internal teams for claim-related queries.
Adhere to process guidelines, quality standards, and TAT.

Eligibility Criteria

Educational Qualification:
Qualified BPT, BDS, BMLT, BAMS, BHMS, BUMS
B. Pharma (minimum 6 months experience required)





Experience:
Minimum 6 months of relevant claims experience preferred.
Freshers considered with qualifications BPT, BDS, BMLT, BAMS, BHMS, BUMS would be considered.

Skills Required
Familiar with US Healthcare domain knowledge and understanding of healthcare regulations (HIPAA)
Deep understanding of medical records and medical terminologies
Ability to produce high quality in production setting.
Basic knowledge of medical terminology and healthcare processes.
Understanding of medical insurance and claims processing.
Valuable analytical and decision-making skills.
Valuable computer knowledge and documentation skills.
Typing speed of 25 Words per Minute with 90% Accuracy
Proficiency in healthcare information systems
Ability to navigate through multiple applications
Ability to understand and question established process guidelines for possible process improvements
Attenti

📌 Medical Claims Noida
🏢 Mancraft Consulting
📍 Noida