3.0 - 7.0 years

0 Lacs

hyderabad, telangana

On-site

You will play a crucial role in supporting various initiatives that enhance the healthcare financial experience at Zelis India. Your responsibilities will include managing the settlement of provider claims, acting as a specialist for the team. This position requires strong negotiation skills, a deep understanding of claims processes, and the ability to support and guide junior team members. Your duties will involve investigating and settling provider and client billing inquiries, including renegotiating claims to secure savings and meet or exceed department KPI goals. You will also be responsible for maintaining comprehensive tracking and documentation of all necessary information related to the research and settlement of assigned work. Collaboration with internal teams, such as Client Services, Network and Vendor Management, Out of Network Services, and Bill Review & Audit, will be essential to ensure timely issue resolution. Furthermore, you will be expected to recommend process improvement opportunities within your team's scope and communicate directly with clients to provide status updates and resolved issue notifications to maintain strong customer relations. Adherence to HIPAA and company standards regarding privacy and confidentiality is paramount in this role. Additionally, you will provide support for the Customer Care Team when required and perform any other related responsibilities as assigned. To excel in this position, you should have 3-5 years of experience in medical claims settlement and 5+ years of experience within the healthcare industry. A strong understanding of PPO networks and the ability to interpret Explanation of Benefits, Plan Documents, PPO, and Complementary Network discounts are essential. Outstanding written and verbal communication skills, proficiency in MS Outlook, MS Word, MS Excel, and Internet Explorer, excellent prioritization and organizational skills, and exceptional customer service and telephone communication skills are also required. An Associates Degree is required for this role, while a Bachelor's Degree is preferred to further support your professional growth and development.,

Posted 3 days ago

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Medical Claim Analyst Med-Metrix

2.0 - 6.0 years

0 Lacs

chennai, tamil nadu

On-site

The Medical Claims Analyst plays a crucial role in the organization by handling collections, account follow-up, billing, and allowance posting for assigned accounts. Your responsibilities include meeting daily productivity/quality standards, adhering to established policies and procedures, analyzing claims issues to reduce denials, communicating identified trends to management, initiating appeals when necessary, correcting billing errors, and sending accurate appeals with supporting documentation. You will also assist with special A/R projects, demonstrate analytical skills, maintain confidentiality, and act professionally in all interactions. To qualify for this role, you should have completed at least a High School education, possess experience in medical billing/AR collections, exhibit strong interpersonal and problem-solving skills, demonstrate sound judgment, integrity, and dependability, and have excellent written and verbal communication abilities. A gracious and welcoming personality for customer service interactions is essential. Working conditions for this position may require night shifts. The physical demands include occasional movement in the work area, sitting, manual tasks, operation of tools and office equipment, extending arms, kneeling, and effective verbal communication. The mental demands entail following directions, collaborating with colleagues, and managing stress effectively. The work environment typically has minimal noise levels. If you are seeking a challenging yet rewarding role where you can utilize your skills in medical claims analysis and contribute to the organization's success, this position may be the perfect fit for you. Join our team and be part of a dynamic environment dedicated to delivering high-quality service while upholding patient confidentiality and compliance with HIPAA standards.,

Posted 1 week ago

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