1572 Claims Adjudication Jobs - Page 14

Role- Medical Coder: We are looking to hire an experienced Coder / Sr. Coder with active coding certifications (CPC / CPC-A / CIC / CCS / COC). With strong domain expertise in CPT and ICD (diagnosis) coding, the incumbent should be able to validate the coding after reviewing all relevant medical records ensuring codes are accurate and sequenced correctly in accordance with government and insurance regulations. Working in an evolving healthcare setting, delivering innovative solutions using our shared expertise. Using opportunities to learn and grow through rewarding interactions, collaboration, and the freedom to explore professional interests. Giving priority always to what is best for our ...

Reports to (level of category) : Manager - Operations Role Objective AR is the most essential part in the RCM cycle. It is usually the last step. After Denial management (AR), again the cycle starts till the payment is made by the insurance company. Essential Duties and Responsibilities Establishes and assures compliance with departmental policies and procedures in conformance with corporate policies and procedures. Should be able to manage a team of 25-30 FTEs FTEs will be directly reporting to AM Will be responsible to resolve queries, account reviews and provide training in case required Drive production and quality to the expected level Responsible to identify production and quality issu...

Role- Medical Coder: We are looking to hire an experienced Coder / Sr. Coder with active coding certifications (CPC / CPC-A / CIC / CCS / COC). With strong domain expertise in CPT and ICD (diagnosis) coding, the incumbent should be able to validate the coding after reviewing all relevant medical records ensuring codes are accurate and sequenced correctly in accordance with government and insurance regulations. Working in an evolving healthcare setting, delivering innovative solutions using our shared expertise. Using opportunities to learn and grow through rewarding interactions, collaboration, and the freedom to explore professional interests. Giving priority always to what is best for our ...

Role Objective: To bill out medical accounts with accuracy within defined timelines and reduce rejections for payers. Essential Duties and Responsibilities: Process Accounts accurately basis US medical billing within defined TAT Able to process payer rejection with accuracy within defined TAT. 24*7 Environment, Open for night shifts Good analytical skills and proficiency with MS Word, Excel, and PowerPoint Qualifications: Graduate in any discipline from a recognized educational institute. Good analytical skills and proficiency with MS Word, Excel, and PowerPoint. Good communication Skills (both written & verbal)Skill Set: Candidate should have good healthcare knowledge. Candidate should have...

Role Objective: To bill out medical accounts with accuracy within defined timelines and reduce rejections for payers. Essential Duties and Responsibilities: Process Accounts accurately basis US medical billing within defined TAT Able to process payer rejection with accuracy within defined TAT. 24*7 Environment, Open for night shifts Good analytical skills and proficiency with MS Word, Excel, and PowerPoint Qualifications: Graduate in any discipline from a recognized educational institute. Good analytical skills and proficiency with MS Word, Excel, and PowerPoint. Good communication Skills (both written & verbal)Skill Set: Candidate should have good healthcare knowledge. Candidate should have...

Role Objective Identifying revenue gain opportunity or denial prevention opportunities by reviewing the open AR claims/denied claims Essential Duties and Responsibilities Denied Claim Reviews/Account level reviews Identifying themes/trends through data reviews Coordinating with requirement stakeholders on the issues/themes/trends identifies Publishing assigned reports/tasks Analysis data to identify process gaps, prepare reports and share findings for Metrics improvement. Identifying automation/process efficiencies Maintain a strong focus on identifying the root cause of denials while creating sustainable solutions to prevent future denials. Able to interact independently with counterparts i...

Responsibilities: Assign codes to diagnoses and procedures, using ICD (International Classification of Diseases) and CPT (Current Procedural Terminology) codes. Ensure codes are accurate and sequenced correctly in accordance with government and insurance regulations. Follow up with the provider on any documentation that is insufficient or unclear. Communicate with other clinical staff regarding documentation. Search for information in cases where the coding is complex or unusual. Receive and review patient charts and documents for accuracy. Review the previous day's batch of patient notes for evaluation and coding. Ensure that all codes are current and active. Requirements: Education Any Gra...

Role Objective: Follow up is the most essential part in the RCM cycle. It is usually the last step in the cycle after cash posting. After Denial management (AR Follow up), again the cycle starts till the payment is made by the insurance company. Essential Duties and Responsibilities:Establishes and assures compliance with departmental policies and procedures in conformance with corporate policies and procedures.Manages people and drives retention.Analysis data to identify process gaps, prepare reports. Performance managementFirst level of escalationWork in all shifts on a rotational basisNeed to be cost efficient with regards to processes, resource utilization and overall constant cost manag...

Role Objective Follow up is the most essential part in the RCM cycle. It is usually the last step in the cycle after cash posting. After Denial management (AR Follow up), again the cycle starts till the payment is made by the insurance company. Essential Duties and Responsibilities Establishes and assures compliance with departmental policies and procedures in conformance with corporate policies and procedures. Day-to-day operations People Management (Work Allocation, On job support, Feedback & Team building) Performance Management (Productivity, Quality, One-On-One sessions, KRA, PIP) Reports (Internal and Client performance reports) Work allocation strategy CMS 1500 & UB04 AR experience is...

Responsibilities: Assign codes to diagnoses and procedures, using ICD (International Classification of Diseases) and CPT (Current Procedural Terminology) codes. Ensure codes are accurate and sequenced correctly in accordance with government and insurance regulations. Follow up with the provider on any documentation that is insufficient or unclear. Communicate with other clinical staff regarding documentation. Search for information in cases where the coding is complex or unusual. Receive and review patient charts and documents for accuracy. Review the previous day's batch of patient notes for evaluation and coding. Ensure that all codes are current and active. Requirements: Education Any Gra...

Reports to (level of category) : Senior Operations Manager Role Objective Follow up is the most essential part in the RCM cycle. It is usually the last step in the cycle after cash posting. After Denial management (AR Follow up), again the cycle starts till the payment is made by the insurance company. Essential Duties and Responsibilities Establishes and assures compliance with departmental policies and procedures in conformance with corporate policies and procedures. a) Day-to-day operations b) People Management (Work Allocation, On job support, Feedback & Team building) c) Performance Management (Productivity, Quality, One-On-One sessions, KRA, PIP) d) Reports (Internal and Client perform...

Role Objective: To directly supervise and motivate a team of frontline employees, ensuring day-to-day operations run smoothly, meet performance targets, maintain quality standards, and effectively communicate company goals while fostering a positive work environment and addressing challenges at the operational level, acting as a bridge between management and the workforce. Essential Duties and Responsibilities: Great with Healthcare knowledge Should be aware of all type of payers. Must have good understanding of payer portal for benefits & denials. Should have people centric mindset to manage team Should have verbal and written communication skills, probing skills and denials understanding W...

About The Role Skill required: Talent Development - Learning Operations Designation: Learning Operations Associate Qualifications: Any Graduation Years of Experience: 1 to 3 years What would you do? Improve workforce performance and productivity, boosts business agility, increases revenue and reduces costsTalent Development process. Manage learning solutions, including activities such as registration, vendor management, product support, learning management system.Multi-cultural awareness.Passion for customer service.Team player.MS Office skills:Ability to understand and make sense of large amounts of data in a complex environment, strong Excel & Word skills, working knowledge of other MS Off...

TATA AIG General Insurance Company Limited is looking for Senior Manager - Commercial Claims to join our dynamic team and embark on a rewarding career journey Analysis for the current business practice. Find out the different operational strategies. Work on developing the current operational strategy applied to the company with the most recent technology. Coordinate with the operations manager to take the required steps after brainstorming and research. Optimize the operations in the company. Put the suitable operational strategy to fit with the companys culture. Implement the operational strategy in the different departments of the company. Supervise the strategy, and make sure that all the...

About The Role Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years What would you do? We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating mod...

About The Role Skill required: Talent Development - Learning Operations Designation: Learning Operations Associate Qualifications: Any Graduation Years of Experience: 1 to 3 years What would you do? Improve workforce performance and productivity, boosts business agility, increases revenue and reduces costsTalent Development process. Manage learning solutions, including activities such as registration, vendor management, product support, learning management system.Multi-cultural awareness.Passion for customer service.Team player.MS Office skills:Ability to understand and make sense of large amounts of data in a complex environment, strong Excel & Word skills, working knowledge of other MS Off...

Job Description Associate Claims (Non-Medical) Job Title: Associate Claims Non-Medical Location: Bangalore 5 Days working Role Overview We are seeking a dedicated and empathetic Associate Claims Executive (Non-Medical) to join our health insurance team. The role involves evaluating claims, reviewing documentation, determining coverage, and ensuring smooth and transparent claim settlement. The ideal candidate should have strong analytical skills, attention to detail, and excellent communication abilities to deliver a positive experience for policyholders. Key Responsibilities Claims Evaluation: Review and assess insurance claims to determine validity and payment eligibility. Documentation Rev...

Veradigm Welcome to Veradigm! Our Mission is to be the most trusted provider of innovative solutions that empower all stakeholders across the healthcare continuum to deliver world-class outcomes. Our Vision is a Connected Community of Health that spans continents and borders. With the largest community of clients in healthcare, Veradigm is able to deliver an integrated platform of clinical, financial, connectivity and information solutions to facilitate enhanced collaboration and exchange of critical patient information. We are an Equal Opportunity Employer. No job applicant or employee shall receive less favorable treatment or be disadvantaged because of their gender, marital or family stat...

SUMMARY Job Opening: Retail Staff Location: Jaipur Our client, a UAE-based multinational conglomerate headquartered in Dubai, is seeking freshers to join their retail staff team in Jaipur. This is an excellent opportunity for individuals looking to kickstart their career in the retail industry. Responsibilities: Folding and stacking at basic table. Timely display of received stocks. Upkeep of section. Ensuring a carton-free floor. Maintaining display standards, including signage. Merchandise clearance from the trial room. Ensuring the right product is displayed on the right browser. Providing customers with shopping bags. Requirements Requirements: Minimum qualification of 10th/12th/Graduate...

Roles and Responsibilities: Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy. Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. Understand the process difference between PA and an RI claim and verify the necessary details accordingly. Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of non-availability of tariff. Approve or d...

Roles and Responsibilities: Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Scrutinize the claims, as per the terms and conditions of the insurance policy. Interpret the ICD coding, evaluate co-pay details, classify non-medical expenses, room tariff, capping details, differentiation of open billing and package etc. Understand the process difference between PA and an RI claim and verify the necessary details accordingly. Verify the required documents for processing claims and raise an IR in case of an insufficiency. Coordinate with the LCM team in case of higher billing and with the provider team in case of non-availability of tariff. Approve or d...

Job Title: Team Lead US Healthcare RCM | Immediate Joiners Company: ACN Healthcare Pvt Ltd About the Role: ACN Healthcare Pvt Ltd is hiring a Team Lead US Healthcare RCM to manage and mentor a team of executives. We are looking for candidates with proven leadership skills and hands-on experience in US Healthcare RCM processes. Key Responsibilities: Lead and manage a team of RCM executives to ensure productivity and quality. Monitor performance, provide coaching, and conduct regular reviews. Ensure SLA adherence and maintain client satisfaction. Identify areas of improvement and implement process enhancements. Candidate Profile: Minimum 1+ year of experience as a Team Lead in US Healthcare RC...

Conduct thorough analysis of clinical trial data to identify potential safety concerns. Develop and implement effective safety protocols to mitigate risks associated with medical devices. Collaborate with cross-functional teams to ensure compliance with regulatory requirements. Perform regular audits to ensure adherence to safety standards. Provide training and guidance on safety procedures to staff members. Review and approve safety documents, such as protocols and reports. Job Requirements Strong understanding of clinical trials, medical devices, and regulatory requirements. Excellent analytical and problem-solving skills. Ability to work effectively in a fast-paced environment. Good commu...

Manage and maintain accurate medical data records. Ensure compliance with regulatory requirements and industry standards. Collaborate with cross-functional teams to achieve project goals. Develop and implement effective data management processes. Analyze and interpret complex medical data to inform business decisions. Provide expert guidance on data-related matters to stakeholders. Job Requirements Strong understanding of medical terminology and concepts. Proficiency in data management software and tools. Excellent analytical and problem-solving skills. Ability to work effectively in a fast-paced environment. Strong communication and interpersonal skills. Experience working with IT Service &...

Conduct thorough analysis of clinical trial data to identify potential safety risks. Develop and implement effective safety protocols and procedures. Collaborate with cross-functional teams to ensure compliance with regulatory requirements. Perform regular audits to ensure adherence to safety standards. Provide training and guidance on safety procedures to staff members. Investigate adverse events and report findings to senior management. Job Requirements Strong knowledge of clinical safety principles and regulations. Experience working with medical devices is preferred. Excellent analytical and problem-solving skills. Ability to work effectively in a team environment. Strong communication a...