HC & Insurance Operations Senior Assoc.

As an experienced professional in US healthcare (Non Voice) Provider Data Validation and Provider Data Management, your role involves various key responsibilities: - Training the team on new processes and updates, ensuring everyone is well-informed. - Collaborating with Quality Assurance to manage process knowledge and variances effectively. - Developing Process SOPs, Process Maps, and identifying outliers within the process. - Reviewing Discrepancy reports, identifying gaps, and sharing insights with Team Leads. - Recognizing Non-Value Added (NVA) activities and proposing automation solutions. - Leading teams to efficiently manage daily inventory. - Monitoring QA scores of production resources, conducting reviews, and enhancing overall performance. - Providing floor support to operations and being the first point of escalation for clients in process-related matters, inventory, and performance metrics. - Identifying topics for refresher/re-training, conducting assessments, and certifying staff for different levels of production. - Taking charge and leading the team in the absence of primary leadership. - Coordinating with the quality team to pinpoint root causes and offer suitable solutions to rectify errors. - Ensuring day-to-day transactions adhere to standard operating procedures. - Following work process flows to complete pending tasks and maintain quality and timeliness standards. - Preferred knowledge in Amisys and Cenprov applications. - Proficiency in checking affiliations for Medicaid, Medicare, and Exchange. - Ability to comprehend provider contracts effectively. - Handling Paid claims, recouped claims, claims rejections, and working in claims denial management. - Sound knowledge of the End-to-End provider billing process. - Familiarity with EDI rejection claims and managing patient and provider demographic changes. This position requires a deep understanding of US healthcare processes, strong leadership skills, and the ability to drive operational excellence within the team.,