73 Medicaid Jobs - Page 3

Greetings from Legacy Med Pvt Ltd We are the leading Revenue Cycle Management Company We are hiring for AR Callers & SR. AR Callers for Chennai Location Job profile : Verify patient insurance coverage and eligibility with insurance providers. Document and update patients' insurance and demographic information accurately. Communicate effectively with patients, providers, and insurance companies to resolve eligibility issues. Review and interpret insurance policy details to determine coverage applicability. Coordinate with billing and coding departments to ensure accurate claim submissions. Handle pre-authorizations and pre-certifications as required by insurance policies. Maintain up-to-date knowledge of insurance regulations and industry standards. Experience: A Candidate should have a minimum of 1 Year of Strong Experience in the Verification of Benefits & Eligibility Verification working with a leading Medical billing company Immediate Joiners Preferred Benefits: Pick up and Drop Transport Allowance Night meal pass ( Sodexo ) Referral Bonus Attendance Bonus Ready To Relocate Interested candidates can call or WhatsApp Vignesh - 8939118694 / Vignesh.munuswamy@legacyhealthllc.com

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 knowledge of Medicare and Medicaid. Ability to interact positively with team members, peer group and seniors.

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 knowledge of Medicare and Medicaid. Ability to interact positively with team members, peer group and seniors.

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 knowledge of Medicare and Medicaid. Ability to interact positively with team members, peer group and seniors.

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 knowledge of Medicare and Medicaid. Ability to interact positively with team members, peer group and seniors.

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 knowledge of Medicare and Medicaid. Ability to interact positively with team members, peer group and seniors.

Role Objective Follow up is the most essential part in the RCM cycle. It is usually the last step in the cycle after cashposting. 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 management Must operate utilizing aggressive operating metrics. Qualifications: Graduate in any discipline from a recognized educational institute (Except B.Pharma, M.Pharma, Regular MBA, MCA B.Tech Freshers') Good analytical skills and proficiency with MS Word, Excel and Powerpoint (Typing speed of 30 WPM) Good communication Skills (both written & verbal) Skill Set: Candidate should be good in Denial Management Candidate should have knowledge of Medicare, Medicaid & ICD & CPT codes used on Denials Ability to interact positively with team members, peer group and seniors. Subject matter expert in AR follow up Demonstrated ability to exceed performance targets Ability to effectively prioritize individual and team responsibilities Communicates well in front of groups, both large and small.

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/Applications to 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 Learn & adapt as per the changing needs of the process. Will have to go thru ongoing Trainings (for performance / process needs) Should be flexible to be moved across the processes assigned by the Manager (Cater to ongoing process requirements) Will have to work as per the prescribed KPI`s / Targets assigned by the Process Manager. Maintain compliance with all company policies and procedures. Ensure - Non-Disclosure of any PHI. 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) Excellent verbal and written communication skills effectively communicate with internal and external customers. Must have proven track record of performance in previous assignment. Maintaining a positive attitude and providing exemplary customer service Ability to work independently and to carry out assignments to complete within parameters of instructions / SOP. Skill Set: Candidate should have knowledge of Medicare and Medicaid. Ability to interact positively with team members, peer group and seniors. Medical Coding and Medical transcription knowledge/experience are considered as relevant. Candidate should have good healthcare knowledge.

Summary Your role in our mission Skills and Competencies: Regulatory Knowledge : Familiarity with US pharmacy & Drug rebate domain, prior authorization processes , Medicaid regulations, including DUR & formulary management Technology Proficiency : Proficiency with pharmacy management systems and electronic health records (EHR) Clinical Expertise : Strong clinical knowledge, including drug therapy management and patient counseling Communication : Excellent verbal and written communication skills What we're looking for Education and Experience Doctor of Pharmacy (PharmD) or Bachelors Degree in Pharmacy (B.Pharm) required State Pharmacist License : Active, unrestricted license to practice pharmacy in any state. Preferable not mandatory. Experience : Total years of exp. Should be 18+ years and 10+ years of experience in a clinical pharmacy setting, preferably with US Medicaid/Medicare What you should expect in this role Client or office environment / may work remotely Occasional evening and weekend work

Job Summary : We are seeking a highly skilled and experienced Configuration Analyst to join our team. The ideal candidate will have extensive knowledge of Healthcare Payer operations and a strong experience in developing and delivering configuration on Claims platforms like Core Admin platforms. This role is essential for ensuring that our staff are well-trained and knowledgeable about industry standards, processes, and best practices. Minimum Required Skills and Qualifications: Minimum of 3+ years of experience in Configuration on either HealthRules Payer or Facets or QNXT is required (US Health insurance). Proven experience with configuration for Medicare, Medicaid, Commercial, and Individual-Exchange lines of business. Experience with HealthEdge HealthRules Payer (HRP) configuration would be preferred Experience with HealthEdge Source (Burgess) or HealthEdge GuidingCare would be added advantage. If interested kindly share your CV to deepalakshmi.rrr@firstsource.com / 8637451071

Experience - 2-3 years of experience in relevant payment posting (ERA Posting, Lockbox Posting, OTC Payments, Credit Balance Review, Statements Review/Release, Refunds) is mandate should have in-depth knowledge in all payer guidelines and COB codes pertinent to payment posting Should be well-versed with Gov-plans and Non-Gov Plans Having knowledge charge posting is added advantage kills: Typing speed 60 to 80 wpm, good written and oral communication, Able to work under pressure and deliver expected daily productivity targets. Ability to work with speed and accuracy Should have willingness to work over the weekends Job Responsibilities Production process Delivering the required quality & TAT Quality check on final files Updating the production reports Desired Qualities Behavior: Discipline, Positive Attitude & Punctuality. Flexible to work in any shift & weekends. Knowledge: Basic knowledge of computers & Data entry.

We are looking for a highly skilled and tech-savvy customer support specialist who can provide exceptional support to our U.S.-based healthcare clients. The ideal candidate must have strong knowledge of electronic medical records (EMRs), U.S. healthcare policies, and regulations, along with outstanding problem-solving skills in IT and technology-related issues. A clear American English accent is required to ensure seamless communication with customers. Key Responsibilities: Provide level 1 and level 2 technical and customer support for healthcare clients using our AI and blockchain solutions. Troubleshoot and resolve issues related to EMR/EHR systems, medical billing software, and other healthcare technologies. Assist clients with IT-related challenges, including software integrations, cloud-based solutions, and data security concerns. Educate customers on healthcare compliance requirements, such as HIPAA, Medicare, Medicaid, and telehealth policies. Work closely with internal teams (IT, product development, and sales) to escalate and resolve complex technical issues. Maintain accurate records of customer interactions and issue resolutions in a CRM system. Ensure high customer satisfaction by providing clear, concise, and professional communication. Required Qualifications: 3+ years of experience in customer support for healthcare IT solutions or electronic medical records (EMR) systems. Strong understanding of U.S. healthcare regulations, HIPAA compliance, and medical billing practices. Excellent troubleshooting skills in IT, software applications, and system integrations. Fluent in English with a clear American accent (must be comfortable speaking with U.S. clients). Experience using CRM software, ticketing systems, and remote support tools. Strong interpersonal skills and the ability to explain technical concepts to non-technical users

Qualification:- Doctor of Medicine, Physician, Doctor of Medicine, MBBS/BAMS/BHMS/BDS Desired healthcare certifications: 1. CPC or COC (AAPC) 2.0CCS (AHIMA) Required / Essential skills. Experience in Claims adjudication process end-to-end Ability to learn and become proficient using an integrated payment integrity technology platform 2 years experience in claims that demonstrates knowledge in HIPAA guidelines, ICD-10 coding, CPT/HCPCS/HIPPS coding Experience in the health care industry (Medicare, Medicaid, and/or Commercial) Advanced proficiency in MS word, Excel, and PowerPoint Proficiency in written and verbal communication Effectively coordinate with the internal team and stake holders Ability to work independently and as a team Keep up to date on industry trends and opportunities to apply best practices to payment integrity and claims processing Ability to think analytically, apply analytical techniques and to provide in-depth analysis and recommendations to senior management using critical thinking and sound judgement Must be a team player and adaptable to a dynamic work environment Proven interpersonal skills Strong written and verbal communication skills Good analytical, decision making and problem-solving skills Strong clinical knowledge and effective use of multiple applications, systems, and resources.

Job Title: Configuration Analyst Location: India Grade: F2 Department: BPaaS Reports To: BPaaS Configuration Director/ Configuration Lead Job Summary: We are seeking a highly skilled and experienced Configuration Analyst to join our team. The ideal candidate will have extensive knowledge of Healthcare Payer operations and a strong experience in developing and delivering configuration on Claims platforms like Core Admin platforms. This role is essential for ensuring that our staff are well-trained and knowledgeable about industry standards, processes, and best practices. Configuration Analyst Location: Any Location (WFH) Shift Time - Night Shift Duties and Responsibilities: Configuration of Healthcare Payer (Health Plan) Core Administrative Platforms: Design and Configure the benefits, system parameters, and pricing requirements on the Health Plan (Payer) core administrative platforms for various lines of business, including Medicare, Medicaid, Commercial, and Individual-Exchange, ensuring compliance with business requirements and regulatory standards. Requirements Gathering and Analysis: Collaborate with clients and internal stakeholders to gather and document configuration requirements, ensuring a clear understanding of client needs and project objectives. Configuration Design and Execution: Develop detailed configuration designs, incorporating feedback from clients and internal stakeholders, and obtain approval prior to implementation. Execute configuration activities as per the approved design, ensuring accuracy and alignment with client specifications. Testing and Quality Assurance: Partner with the testing team to conduct thorough testing of configurations, review results, and make necessary adjustments to ensure quality and performance standards are met. Minimum Required Skills and Qualifications: Minimum of 2+ years of experience in Configuration on either HealthRules Payer or Facets or QNXT is required (US Health insurance). Proven experience with configuration for Medicare, Medicaid, Commercial, and Individual-Exchange lines of business. Experience with HealthEdge HealthRules Payer (HRP) configuration would be preferred Experience with HealthEdge Source (Burgess) or HealthEdge GuidingCare would be added advantage Strong communication skills, with demonstrated ability to engage effectively with clients and internal stakeholders.

We are seeking a dynamic and experienced Training Manager to oversee the training needs of a team comprising up to 500-600 employees. • The ideal candidate will have strong leadership skills to manage a team of training trainers and drive the effective execution of training programs. • They will be accountable for various aspects of training, including new hire training, performance monitoring during the initial period, and continuous knowledge management during regular operations. • People Management: Lead and mentor a team of training trainers to ensure they meet their objectives and deliverables effectively Training • Program Development: Collaborate with stakeholders to design comprehensive process training plans tailored to the organization's needs. Assess and enhance the effectiveness of training materials, including Standard Operating Procedures (SOPs), Participant and Facilitator Guides, and Learning Check Points. • Execution and Oversight: Execute training deliverables under the guidance of the Training Manager, ensuring alignment with organizational goals and standards. Conduct audits, Performance Knowledge Transfer (PKT) calibrations with Quality Assurance (QA), and Training Needs Assessments (TNA) for employees in day-to-day operations. • Monitoring and Improvement: Track and provide detailed updates on the progress of training batches, identifying areas for improvement and optimization. Conduct periodic follow-ups on below quality (BQ) employees, providing tailored training and refreshers to enhance performance. • Certification and Development Programs: Organize certification programs and other developmental workshops for auxiliary trainers to enhance their skills and capabilities.• Process Improvement: Regularly review and revise standard operating procedures (SOPs) in consultation with clients, ensuring alignment with best practices and evolving business needs. • Compliance and Reporting: Ensure adherence to training governance mechanisms outlined in the Training Standard Document (TSD).Prepare, publish, and maintain various training reports and dashboards to track key performance indicators and inform decision-making. Qualifications Graduate is a must

Dear All, Greetings from Flatworld Healthcare Services. WE ARE HIRING !! Job Title: CPC Certified Medical Coder in Multi-Specialty (Primary Care, Dental & Chiropractic) Location: Bangalore Shift: Night Shift Experience: 1 - 3 Years Notice Period: Immediate Joiners Preferred Employment Type: Full-Time, Permanent Interested candidates can share their CVs at pavan.v@finnastra.com or contact 9035473861 (Available between 11 AM - 9 PM ). Job Description: We are seeking a CPC-certified Medical Coder with a minimum of 2 years of experience in multi-specialty coding, specifically in Primary Care, Dental, and Chiropractic services within Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC) settings. The ideal candidate should have strong expertise in CPT, ICD-10, HCPCS coding, and compliance with CMS and payer-specific guidelines. Key Responsibilities: Accurate Coding: Assign and review CPT, ICD-10, and HCPCS codes for Primary Care, Dental, and Chiropractic services, ensuring compliance with RHC/FQHC billing regulations. Claims & Compliance: Ensure claims meet payer policies, Medicare/Medicaid regulations, and RHC/FQHC-specific coding guidelines. Audit & Quality Assurance: Conduct internal coding audits, identify discrepancies, and implement corrective actions to improve accuracy. Denial Management: Work with the billing team to review and resolve coding-related denials and rejections. Documentation Review: Collaborate with providers to ensure appropriate documentation supports coding and reimbursement. Coding Education: Provide feedback and training to providers and staff on documentation improvement and coding updates. Stay Updated: Keep abreast of CMS, Medicaid, and commercial payer guidelines , ensuring compliance with evolving industry standards. Qualifications & Skills: Certification: Certified Professional Coder (CPC) from AAPC (Required). Experience: Minimum 2 years of multi-specialty coding experience in Primary Care, Dental, and Chiropractic services. Preferred Experience: Working knowledge of RHC/FQHC billing and coding guidelines. Software Proficiency: Experience with EHR/EMR systems and coding tools . Regulatory Knowledge: Understanding of Medicare/Medicaid billing , HIPAA, and compliance regulations. Analytical & Communication Skills: Strong attention to detail and ability to communicate effectively with providers and billing teams. Preferred Qualifications: Experience with Medicaid and Medicare Advantage plans . Additional certifications such as CRC, COC, or CPMA are a plus. Prior experience in denial management and revenue cycle optimization . Benefits: Competitive salary & performance incentives. Health benefits & professional development opportunities. Flexible work environment ( Remote/Hybrid as per company policy ).

Candidate should have 3+ years of experience in EDI transaction processing, mapping, and troubleshooting for US healthcare payor environment. Shift - Rotational Shifts Work Location - Chennai Required Candidate profile Immediate Joiners OR Max 1 month notice period candidates can apply Call HR Manager Reejo @ 9886360719 for more details.

Minimum 1-3 years of experience working in credentialing. Candidate must have knowledge in END to END provider credentialing Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid. Required Candidate profile Candidate must have knowledge in creating & attesting the CAQH profiles Group Medicare and Medicaid Enrollment/Contracts. Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.

US Health Care Domain Knowledge. E.g. Encounters, EDI, HIPAA, 837 Layout, insights into Medicare and Medicaid, Markets etc. Facets/QNXT or any other healthcare adjudication system knowledge will be added advantage. SQL Server SSIS and SSRS plus any Microsoft cloud technologies will be added advantage. Analytical and Query Writing Skills (SQL) SQL Procedure and Packages Debugging skills. Knowledge on any reporting tools or software e.g. Tableau or Power BI etc. PPT Presentations with client. Should be good at communication skills Shift & Mode of work: US Shift & WFO Interested, kindly share your updated resume to the below email Deepika: deepika.r246382@cognizant.com

Job description Team Executive - Claims Adjudication Location : Hyderabad Roles & Responsibilities: In-depth Knowledge and Experience in the US Health Care Payer System. 4 - 6 years of experience in Claims Adjudication . With over 1 year of experience as a Team leader Proven track record in managing processes, streamlining workflows and excellent people management skills. Need to be a people centric manager who could articulate the employee challenges to the management as well as motivate the team towards desired project goals. Circulate quality dashboards at agreed periodic intervals to all relevant stake holders Adhering to various regulatory and compliance practices. Maintaining and Ownership of reports both internal as well as for the clients. Presenting the data and provide deep insights about the process to the clients as well as Internal Management. Managing and co- ordinating training programs. Excellent in Coaching and providing feedback to the team. Take necessary HR actions as part of the Performance Improvement Process Key Performance Indicators Ensuring that the key Service Level Agreements are met consistently without any exceptions. Leverage all Operational metrices to ensure that the Revenue and Profitability targets are met and exceeded . Work in tandem with all Business functions to ensure smooth business process. Retention of key team members Interested Candidates share your CV - deepalakshmi.rrr@firstsource.com / 8637451071

The SNF Revenue Cycle Manager oversees all billing, coding, A/R, and collections to ensure proper reimbursement for skilled nursing facility services. Key Responsibilities: Manage SNF-specific revenue cycle workflows . Oversee PDPM billing accuracy and Medicaid reimbursements . Work with state Medicaid agencies to resolve claim issues . Analyze aging reports and improve collections performance . Ensure compliance with CMS and state Medicaid billing requirements. Deep knowledge of PDPM, RUG-IV, and Medicaid case-mix reimbursement models .

Project Role : Application Lead Project Role Description : Lead the effort to design, build and configure applications, acting as the primary point of contact. Must have skills : Electronic Medical Records (EMR) Good to have skills : NA Minimum 5 year(s) of experience is required Educational Qualification : 15 years full time education Summary:As an Application Lead, you will lead the effort to design, build, and configure applications, acting as the primary point of contact. You will be responsible for managing the team and ensuring successful project delivery. Your typical day will involve collaborating with multiple teams, making key decisions, and providing solutions to problems for your immediate team and across multiple teams. Key Responsibilities1 Part of a development team working on Regulatory reporting in a US Health Care 2 Responsible for closely working with Client in Requirements Gathering, designing, optimizing/automating, story telling of data, and integration with different Health care programmes / products 3 knowledge on the process of adhering to laws, regulations, standards, and other rules set forth by governments and other regulatory bodiesTechnical Experience1 Must have: USA Medicaid or Medicare programs / Reporting , USA Health Care domain working with Encounter / Claims data 2 Must to have :Programming in python, SAS, writing and debugging complex SQL codes.3 Must to have :U.S. Health care regulations (eg. FDA Regulations, HIPAA).4 Good to have :Experience membership claims billing diagnosis codes , Healthcare Effectiveness Data and Information Set(HEDIS ) experience , Whole Child Model (WCM) program experience, Databricks Professional Attributes1 Requires strong problem solving and communication skills to interpret issues and provide resolution.2 Excellent Team player and exceptional abilities to work well in both the Team and IndividualEducational Qualification1 minimum 15 years of full-time -education Additional Information:- The candidate should have a minimum of 5 years of experience in Electronic Medical Records (EMR)- This position is based at our Chennai office- A 15 years full-time education is required- 2 hrs PST overlap (available between 8 a.m. 10 a.m PST) Qualifications 15 years full time education

Minimum Year(s) of Experience (BQ) *: US 2+ years of experience in US Health care Payer side Certification(s) Preferred: NA Required Knowledge/Skills (BQ): US Healthcare Experience Experience in Appeals & Grievances (A&G, Medicare/Medicaid) Preferred Knowledge/Skills *: Strong verbal and written communication skills, including letter writing experience. Excellent English skills with the ability to read, comprehend, write and communicate verbally with stakeholders & customers. Ability to work with firm deadlines, multi-task, set priorities and pay attention to details Ability to successfully interact with members, medical professionals, health plan and government representatives. Knowledge on Appeals & Grievances and Medicare/Medicaid Proficiency with Microsoft Word, Excel, and PowerPoint. Excellent organizational, interpersonal and time management skills. Must be detail-oriented and an enthusiastic team player. Knowledge of Pega computer system a plus. Responsibilities: As an Associate, youll work as part of a team of problem solvers with consulting and industry experience, helping our clients solve their complex member, provider and business issues. Specific responsibilities include, but are not limited to: Analyzes, evaluates and resolves member & provider appeals, disputes, grievances, and/or complaints from health plan members, providers and related outside agencies in accordance with the standards and requirements established by the Centers for Medicare and Medicaid and/or health plan. Prepares and organizes case research, notes, and documents. Contacts the member/provider through written and verbal communication. Requests, obtains and reviews medical records, notes, and/or detailed bills as appropriate. Applies contract language, benefits, and review of covered services. Conducts research, fact checking and analysis and recommends appropriate course of action and next steps for management review. Research claim / service authorization appeals and grievances using support systems to determine appeal and grievance outcomes inclusive of claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error. Determines appropriate language for letters and composes all correspondence and appeal/dispute and or grievances information concisely and accurately, in accordance with regulatory requirements. Communicates resolution to members (or authorized) representatives. Works with provider & member services to resolve balance bill issues and other member/provider complaints. Assures timeliness and appropriateness of responses per state, federal and health plan guidelines. Responsible for meeting production standards set by the department. Prepares appeal summaries, correspondence, and document findings. Include information on trends if requested. Desired Knowledge / Skills: 2+ years of experience in US Health care Payor side 1 + years of processing experience in Appeals & Grievance Denial Management Knowledge on US Health Care, Claims Adjudication, Rework & A&G Experience Level: 1+ years Shift timings: Flexible to work in night shifts (US Time zone)