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 Robust 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 workplace
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 handling, clarifying concerns, and seeking support
AM/LAM for the purpose of settling issues left unresolved by the SME and monthly evaluation of performance
SME for the purpose of handling process related issues; queries and escalated transactions
QCA for the purpose of associate performance feedback and audit in order to update the training curriculum
Mentors for the purpose of seeking clarifications and answering queries real time

📌 Executive Noida
🏢 EXL
📍 Noida