1604 Claims Adjudication Jobs - Page 24

1. Handle Provider Chat queries and meet client SLA 2. 5-10 Operation during weekdays 3. Should have a valid degree & good in communication 4. Adhere to client shift time and break hours 5. Customer holidays are followed and hence need to work on India Holidays 6. Should have experiance in handling Microsoft excel, words

About Us: Medi Assist is India's leading Health Tech and Insure Tech company focused on administering health benefits across employers, retail members, and public health schemes. We consistently strive to drive innovation and participate in such initiatives, to lower health care costs. Our Health Benefits: Administration model is designed to deliver the tools necessary for a health plan to succeed, whether its our modular claims management system, our technology that unveils data to make important decisions, or our service solutions built around the voice of the customer. In short, our goal is to link our success to that of our members Roles and Responsibilities: Check the medical admissibil...

Positions General Duties and Tasks: Process Insurance Claims timely and qualitativelyMeet & Exceed Production, Productivity and Quality goals Review medical documents, policy documents, policy history, Claims history, system notes and apply the trained client level business rules to make appropriate Claims decisions, call out claims trends and flag fraud activities Stay up to date on new policies, processes, and procedures impacting the outcome of Claims processing Be a team player and work seamlessly with other team members on meeting customer goals Requirements for this role include: Both Under Graduates and Post Graduates can apply. Excellent communication (verbal and written) and custome...

Position's General Duties and Tasks In these roles you will be responsible for: Performing outbound calls to insurance companies (in the US) to collect outstanding Accounts Receivables. Responding to customer requests by phone and/or in writing to ensure customer satisfaction and to assure that service standards are met Analyzing medical insurance claims for quality assurance Resolving moderately routine questions following pre-established guidelines Performing routine research on customer inquiries. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Requirements for this role include: Ab...

"1. Handle Provider Chat queries and meet client SLA 2. 5*10 Operation during weekdays3. Should have a valid degree & good in communication 4. Adhere to client shift time and break hours 5. Customer holidays are followed and hence need to work on India Holidays 6. Should have experiance in handling Microsoft excel, words"

Roles and Responsibilities: 2-3 years of experience in processing claims adjudication and adjustment process Experience in professional (HCFA) and institutional (UB) claims Knowledge in handling authorization, COB, duplicate and pricing process Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations Audit claims as outlined by Policies and Procedures. Utilize appropriate system-generated reports applicable for specialty claims. Document, track findings per organizational guidelines for reporting purpose. Based upon trends, determine ongoing Claims E...

Medical Officer (MBBS/BAMS/BHMS) at Good Health Insurance TPA. Responsible for cashless request processing, claim review, ICD coding, and policy adherence. Freshers can apply. Strong medical knowledge and computer skills required.

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: Payers either send an EOB (explanation of benefits) or ERA (electronic remittance advice) towards the payment of a claim. The cash/payment posting staff posts these payments immediately into the respective patient accounts, against that claim to reconcile them. Essential Duties and Responsibilities: Need to work on payment posting and denial batches. Must work on ERA discrepancies. Need to do bank reconciliation. 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 ...

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 ...

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...

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- 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 PowerPointQualifications: 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: 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...

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 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...

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...

We are looking for a skilled professional with 8 to 14 years of experience to join our team as an Assistant Manager - Delivery in Chennai. Roles and Responsibility Manage and oversee the delivery of healthcare services to ensure high-quality patient care. Coordinate with healthcare professionals to develop and implement effective treatment plans. Monitor and analyze patient outcomes to identify areas for improvement. Collaborate with cross-functional teams to resolve issues and improve service quality. Develop and maintain relationships with key stakeholders, including patients, families, and healthcare providers. Identify and mitigate risks associated with healthcare service delivery. Job M...

H.Sc / Graduate freshers with good communication. US healthcare Exp will be an advantage. Knowledge of basic computer operations. Willingness to work in the late evening and night shifts. Courteous with strong customer service orientation. Good listening and speaking skills. Typing speed 30/90% Work from office only Mandatory Skills: Commercial.

About Us: Medi Assist is India's leading Health Tech and Insure Tech company focused on administering health benefits across employers, retail members, and public health schemes. We consistently strive to drive innovation and participate in such initiatives, to lower health care costs. Our Health Benefits: Administration model is designed to deliver the tools necessary for a health plan to succeed, whether its our modular claims management system, our technology that unveils data to make important decisions, or our service solutions built around the voice of the customer. In short, our goal is to link our success to that of our members Roles and Responsibilities: Check the medical admissibil...

Designation : Operations Manager Location: Sec-21 GGN 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 performance ...

Position Title: Operation Delivery Leader (Coding Quality) Function: Coding Location: Hyderabad Shift Timings: 12:00 to 22:00 Hrs. (flexible) Reporting To: Director Responsibilities: Lead a team of quality senior managers/managers/ assistant managers for multiple business units/customers and across locations. Lead closer calibrated quality outcomes for end customers. Drive customer satisfaction for quality of coding output including corrective and preventive actions for customer quality concerns. Build and operate a predictable quality model and well aligned outcome-based quality assurance unit for coding. Actively collaborate new customer engagements for better quality outcomes including ca...