4 Healthcare Claims Jobs

You will be responsible for processing healthcare claims by reviewing and adhering to established policies and procedures. This includes verifying patient demographics, insurance information, and medical coding accuracy, as well as ensuring all necessary documentation is submitted with the claims. In cases of claim discrepancies and denials, you will conduct research and resolve the issues effectively. Monitoring clearinghouse rejections and claim edits within the core billing system will also be a key part of your role. Analyzing rejection and edit reports to identify root causes of claim issues, correcting errors, and working with clearinghouse representatives to resolve technical issues are important tasks. Additionally, you will be expected to develop strategies to prevent recurring clearinghouse rejections and claim edits. Maintaining a strong understanding of the core billing system and its claims processing functionalities is essential. You will utilize the system to research claim status, rectify errors, and generate reports. Any system issues identified should be reported to the IT department or system vendor. Participation in system testing and upgrades to ensure compliance with regulations and guidelines is also required. Accurate documentation of all claim processing activities in the billing system is crucial. Furthermore, you will prepare reports on claim processing metrics such as rejection rates, denial rates, and turnaround times. Identifying trends and proposing solutions to claim issues based on the gathered data will be part of your responsibilities. As a senior team member, you will serve as a mentor for junior Claims Processing Specialists. Providing guidance and support on complex claim issues, as well as assisting in training new team members on processing procedures and systems, will be expected from you. Your role will also involve identifying opportunities to enhance claims processing efficiency and accuracy. Active participation in process improvement initiatives and projects, along with the development and implementation of best practices, will be vital to your success in this position. Preferred qualifications for this role include a Bachelor's degree in a relevant field, 3-5 years of experience in medical claims processing, familiarity with clearing houses, and in-depth knowledge of claims processing workflows and procedures. Strong analytical skills, proficiency in billing software and clearinghouse portals, excellent communication, and interpersonal abilities are also required. Additionally, experience with EPIC and both Hospital and Professional billing would be advantageous, though not mandatory. This is a full-time position with health insurance and provident fund benefits. The work location is in person.,

As an Executive in the US Medicare Process team, you will be responsible for managing healthcare claims, verifying medical eligibility, and ensuring compliance with Medicare guidelines. With 1-4 years of experience in the field, you will play a crucial role in processing Medicare claims accurately and resolving any discrepancies that may arise. Your role will involve handling inbound and outbound calls for claim inquiries, updating medical eligibility records as per Medicare regulations, and reviewing healthcare provider documentation in alignment with US Medicare standards. Your key responsibilities will include processing Medicare claims with precision, verifying and updating medical eligibility records, and communicating effectively with healthcare providers and patients. You will need to ensure timely and accurate processing of claims while adhering to HIPAA and other healthcare data protection regulations. Additionally, you will be required to assist in resolving issues related to claim rejections or denials and maintaining up-to-date patient and provider information in the system. To excel in this role, you should possess a Bachelor's degree in any field, with a preference for a background in healthcare. Your 1-4 years of experience in the US Medicare or healthcare BPO domain will be beneficial, along with a strong understanding of Medicare processes and regulations. Excellent communication skills, proficiency in MS Office and healthcare management software, attention to detail, and organizational abilities are key qualifications required for this role. Flexibility to work in shifts, if needed, will also be essential. Preferred qualifications include prior experience in US healthcare claims processing or medical billing, knowledge of healthcare compliance and HIPAA guidelines, and familiarity with Electronic Health Records (EHR) or similar systems. In return, you can expect a competitive salary of up to 26,000 per month, health insurance, and other benefits as per company policy. This is an excellent opportunity to work with a leading healthcare process management team and contribute to the efficient processing of Medicare claims.,

As a Health Admin Services New Associate at Accenture, you will be a part of the Healthcare Claims team responsible for the administration of health claims. Your role will involve core claim processing tasks such as registering claims, editing & verification, claims evaluation, and examination & litigation for health, life, and property & causality claims. You will play a crucial role in embedding digital transformation in healthcare operations end-to-end, driving superior outcomes and value realization today, while enabling streamlined operations to serve the emerging health care market of tomorrow. We are looking for individuals who are adaptable, flexible, and have a commitment to quality. A process-oriented mindset, results orientation, and strong written and verbal communication skills are essential for this role. As a Health Admin Services New Associate, you will be responsible for solving routine problems following general guidelines and precedents. Your primary interactions will be within your team and with your direct supervisor. You will receive detailed instructions on tasks, and decisions made will impact your work closely supervised. This role requires you to work as an individual contributor within a team with a predetermined, narrow scope of work. Please note that rotational shifts may be required for this role. If you are a recent graduate with 0 to 1 years of experience and have a passion for healthcare claims administration, this opportunity at Accenture could be the perfect fit for you. Join our global professional services company with leading capabilities in digital, cloud, and security, and be part of a team that embraces change to create value and shared success for clients, people, shareholders, partners, and communities.,

Designation: SME - Denial Management Experience: 2-3 years Skills desired: Detailed knowledge of US healthcare billing cycle Experience working with different EMR/EHR systems like Epic, Cerner, Allscripts, Athenahealth, NextGen, eClinicalWorks, Meditech, etc. Denial analysis and management - Review and analyze denied insurance claims to identify cause of denials such as coding issues, preauthorization, payer-specific policies - Develop and track denial log to monitor patterns and trends in denied claims - Experience talking with payers to obtain clarification with denials and initiate timely appeals when appropriate Expertise in working with denial reason codes (CARC, RARC) and identifying root causes of denials. Strong understanding of billing regulations, CPT, ICD-10, HCPCS codes, and compliance standards (HIPAA, CMS guidelines). Appeals - - Understand 1st, 2nd, 3rd, and External Level Appeal process, system, and documentation SOP - Prepare, submit, and follow up on appeals ensuring all necessary documentation is included - Revie Review assigned denials and EOBs for appeal filing information. Gather any missing information - Review case history, payer history, and state requirements to determine appeal strategy - Obtain patient and/or physician consent and medical records when required by the insurance plan or state - Gather and fill out all special appeal or review forms - Create appeal letters, attach the materials referenced in the letter, and mail them Maintain a record of all appeals and responses to track appeal outcomes and recovery rates Monitor payer response timelines to ensure appeal filing deadlines are met Track insurance company and state requirements and denial trend changes