3165 Claims Processing Jobs - Page 49

Overview The Provider Enrollment Specialist works in conjunction with the Provider Enrollment Manager to identify Provider Payer Enrollment issues or denials. This position is responsible for researching, resolving, and enrolling any payer issues, utilizing a variety of proprietary and external tools. This will require contacting clients, operations personnel, and Centers for Medicare & Medicaid Services (CMS) via phone, email, or website Responsibilities Performs follow-up with market locations to research and resolve payer enrollment issues Performs follow-up with Centers for Medicare & Medicaid Services (CMS), and other payer via phone, email or website to resolve any Payer Enrollment iss...

Claims Management: Process, submit, and follow up on insurance claims, resolving discrepancies and denials with insurance providers. Patient Assistance: Educate patients on their insurance coverage and benefits and assist them with understanding their bills and statements. Liaison with Insurers: Serve as a point of contact between the hospital and insurance companies, ensuring proper communication and adherence to policies. Data and Reporting: Maintain accurate patient insurance information in the billing system and prepare reports on billing and insurance activities. Compliance: Ensure adherence to hospital policies and insurance regulations and guidelines Skills: Excellent communication an...

Overview: We are seeking an experienced Insurance Domain Expert to lead data migration projects within our organization. The ideal candidate will have a deep understanding of the insurance industry, data management principles, and hands-on experience in executing successful data migration initiatives. Key Responsibilities: 1. Policy Administration Handled quoting, rating, underwriting, policy issuance, endorsements, renewals, and cancellations. Exposure on Tools: Guidewire PolicyCenter, Duck Creek worked on policy admin Data components: Product models, customer attributes, risk factors supported Integrations with CRM, payment gateways, general ledger 2. Billing Management Managed the entire ...

In this Role you will be Responsible For Review and process insurance claims. Validate Member, Provider and other Claims information. Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedure. Coordination of Claim Benefits based on the Policy & Procedure. Maintain productivity goals, quality standards and aging timeframes. Scrutinizing Medical Claim Documents and settlements. Organizing and completing tasks per assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Resolving complex situations following pre-established guidelin...

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...

"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...

ROLE & RESPONSIBILITIES Preauthorization claim processing Manage the Turnaround time. Quality adjudication with Errorless Rotational basis shift (8 AM to 10:30 PM) WFO only QUALIFICATION & EXPERIENCE: BHMS/BAMS/BUMS/BDS/BPT 1-2 years Experience Knowledge of insurance field Strong medical knowledge Fresher also can apply KEY COMPETENCIES & SKILLS REQUIRED MS office Communication Medical knowledge/disease knowledge Note- Interested candidates can share their resume at vishali.massey@nivabupa.com

Int. voice process US Process Location : AHMEDABAD 5days working Saturday-Sunday off Salary : 20K CTC ( FRESHERS ) Up to 35K CTC (EXPERIEND ) Night Shift CAB FACILITY AVAILABLE GRADUATION MANDATORY NO TARGET AND NO SALES

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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.

We are hiring for International Healthcare Customer Support. Role & responsibilities : Handle outbound calls related to healthcare services within the US healthcare system. Proactively reach out to members to provide support, resolve issues, and ensure a positive experience. Identify and address varying levels of member complexity and communicate effectively. Ensure strict compliance with HIPAA regulations and other healthcare-related guidelines. Resolve member inquiries efficiently and professionally, escalating complex cases as required. Preferred candidate profile Proven experience in outbound voice processes, preferably in the US healthcare sector. Strong verbal and written communication...

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: 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 : Authorization Creation is a process where we need to coordinate with the nurses for decrypting the medical records & reports. Essential Duties and Responsibilities Interact with the US health insurance companies (Insurance Customer Care/Nurses/UM Team) Quality of Notation, Ability to read clinical documentation and data enter for payer requirements. 80%+ Calling will be involved (may vary site to site), should be open to Voice based work Would secure relevant information of Health Insurance of the patient. Work on Websites/Applicationsto perform the activity as per the SOP. Would be working in 6pm to 3 am & 9pm to 6am, Supporting US operations (in EST Zone) Should be Open to...

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...

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 management First level of escalation Work in all shifts on a rotational basis Need to be cost efficient with regards to processes, resource utilization and overall constant cost...

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...

Key Roles & Responsibilities Design, develop, implement, and maintain complex integrations between Guidewire (PolicyCenter, BillingCenter, ClaimCenter) and external systems (legacy applications, third-party services, etc.) using APIs, web services, and message queues. Analyze business requirements and translate them into technical solutions leveraging Guidewire's integration capabilities (e.g., ITypes, Business Services, Datamaps). Write clean, well-documented, and maintainable code adhering to best practices and Guidewire development standards. Conduct unit testing and participate in integration testing with QA and other teams. Troubleshoot and resolve integration issues to ensure smooth da...

The staff has to perform the work of chief Contract expert and needs to monitor the EPC-Contracts Qualifications Graduate in discipline. 20+ years in railway or railway related industry, out of which minimum 10 years in Metro/MRTS. Shall have worked in atleast one metro project.