Associate / Senior Associate

Hi Everyone,

Greeting from Primera,

We are hiring the candidates who have experience in to claims adjudication.

Role & responsibilities

• Familiarity with CMS-1500 and UB-04 claim forms.
• Knowledge of CPT/HCPCS codesKnowledge of revenue codes, Type of Bill and place of services.
• Knowledge in pricing professional claims using fee schedules, RVUs, and modifiers.
• Understanding of institutional pricing methods: DRG, per diem, APC classifications, and bundling rules.
• Ability to validate copay and coinsurance accurately based on member benefits.
• Knowledge of deductible and cost-sharing mechanisms.
• Skills to verify and validate prior authorizations.
• Ability to interpret Division of Financial Responsibility (DOFR) tables in contracts.
• Proficiency in applying NCCI/PTP edits and multi-procedure reductions.
• Ability to validate payable codes and review modifiers for compliance

Please share your resume at npeddalingannagari@primehealthcare.com / 9154957481.