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Coordinator-Claims Analyst-Repricing and Extended functions

Coordinator-Claims Analyst-Repricing and Extended functions

EXL

2 - 6 years

0 Lacs

chennai tamil nadu

Posted:1 week ago| Platform: Shine logo

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Skills Required

clinical documentation medical necessity claims processing hipaa cms regulatory guidelines compliance reports summaries quality assurance coding standards icd cpt hcpcs claim submissions patient records healthcare providers medical record handling process improvements internal audits healthcare terminology insurance claim procedures

Work Mode

On-site

Job Type

Full Time

Job Description

As a Medical Claims Auditor, your role involves verifying that all essential clinical documentation is included to support claim submissions and medical necessity. You will need to identify and resolve inconsistencies, errors, or missing documentation in patient records or claims. It is crucial to prioritize and manage workloads effectively to ensure expedited processing of high-priority cases within defined timelines. Your responsibilities will include collaborating with healthcare providers, coders, and billing staff to obtain or clarify necessary information. Adherence to compliance standards such as HIPAA, CMS, and other regulatory guidelines related to medical record handling and claims processing is essential. Additionally, you will be expected to prepare accurate reports and summaries of claim findings, trends, and potential process improvements. To support internal audits and quality assurance initiatives, you will provide detailed documentation and analytical insights. It is essential to maintain a strong understanding of healthcare terminology, coding standards (ICD, CPT, HCPCS), and insurance claim procedures to excel in this role. Qualifications Required: - Proficiency in healthcare terminology, coding standards (ICD, CPT, HCPCS), and insurance claim procedures. - Experience in medical claims auditing or a related field would be advantageous. - Strong attention to detail and the ability to prioritize and manage workloads effectively. - Knowledge of compliance standards such as HIPAA, CMS, and other regulatory guidelines. - Excellent communication and collaboration skills to work with healthcare providers, coders, and billing staff effectively.,

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Coordinator-Claims Analyst-Repricing and Extended functions