Process Associate – Healthcare Payors 56 views

Responsibilities

  • The candidate will be responsible for conducting audits on healthcare claims to identify any billing aberrancy basis the clinical recommendations/judgment and review of the invoice, medical documents (if any), and payer-specific policies and guidelines
  • Identify any specific billing patterns or trends from different providers monthly
  • Communicate and coordinate with the clinical coordinator from client-side
  • Demonstrate ability to consistently meet or exceed targets and benchmarks
  • Maintain audit log and prepare and share MI from the audit log
  • Handle Customer Queries from providers or members via emails.

Qualifications we seek in you!
Minimum qualifications

  • Graduate (Preferably BHMS/BUMS)
  • Good knowledge of healthcare & medical terminologies

Preferred qualifications

  • Eye for detail & investigative skills
  • Good interpretation & comprehension skills
  • Excellent medical/clinical Knowledge across specialties, such as internal medicine, surgery, orthopedics, neurology, etc.
  • Excellent communication skills (written & verbal)
  • Demonstrable analytical skills specific to clinical audit in practice
  • Customer Orientation and Solution-oriented
  • Ability to ask the right queries
  • Ability to prioritize and organize own workload

More Information

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