Description
Claims Review and Verification

Conduct post-audit reviews of healthcare claims to ensure accuracy and compliance with payer policies, regulations, and billing guidelines.

Verify that claims are billed correctly, including checking codes, modifiers, and the application of perks.

Error Identification and Resolution:

Identify and analyze discrepancies or errors in claims processing.

Work with claims processors and providers to resolve issues or discrepancies.

Prepare and document findings and recommendations for corrections.

Responsibilities
Ensure that claims processing adheres to federal, state, and payer-specific regulations.

Stay updated on changes in healthcare regulations and payer policies to ensure compliance.

Reporting and Documentation

Generate detailed reports on audit findings, including error trends, compliance issues,



and recommendations for process improvements.

Maintain accurate records of audits, findings, and resolutions.

Process Improvement:

Analyze audit results to identify areas for process improvement within the claims processing system.

Collaborate with internal teams to implement changes and improve claim accuracy and efficiency.

Provider and Payer Communication:

Communicate with healthcare providers and payers regarding audit findings, discrepancies, and required corrections.

Provide guidance and support to resolve issues related to claim processing.

Qualifications
Bachelor Degree in relevant field with 2 - 4 years of relevant experience

📌 Assistant Manager (India)
🏢 EXL
📍 India