Description

Job Description

Position Title, Responsibility Level:Executive/Senior Executive

Function:

Operations

Reports to -

Assistant Manager/Lead Assistant Manager

Permanent/ Temporary: Permanent

Span of Control –

None

Location:

C – 15, Noida

Basic Function

This position is responsible for reviewing, analyzing and interpreting medical Information to assess and determine appropriate next action steps which may lead to denial or payment of claims.

Work is performed under general supervision according to established guidelines. This individual promotes capabilities from a customer perspective, aligning needs with the target offering by creating a customer self-service enabled platform for core customers.

Essential Functions
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
Attention for detail,



and Solid analytical skills for processing medical documentation
Critical thinking and high independent decision making capability
Proficiency in healthcare information systems
Ability to navigate through multiple applications
Operates with urgency in a real time service setting
Meets individual goals while assisting team to meet team goals
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)
May perform other duties as assigned
Making outbound calls to agent, hospitals, pharmacy and doctors office to capture missing or required information

Performance parameters
Productivity
Quality
Turn Around Time of work assigned
Attendance & Schedule Adherence

Primary Internal Interactions:
SME/AM/LAM/Manager for the purpose of reporting performance, escalation h

📌 Senior Executive Noida
🏢 EXL
📍 Noida