105 Medicaid Jobs - Page 4

|| We Are Hiring || AR Callers || Locations :- Hyderabad, Chennai & Mumbai || PHYSICIAN BILLING : Experience :- Min 1 year of experience into AR Calling - Physician Billing Package :- Up to 40K Take home Locations :- Hyderabad , Mumbai , Chennai, Noida & Gurugram Qualification :- Inter & Above Notice Period :- 0 - 20 days WFO HOSPITAL BILLING : Experience :- Min 1 year of experience into AR Calling - Hospital Billing Package :- Up to 43K Take home Locations :- Hyderabad , Mumbai , Chennai, Noida & Gurugram Qualification :- Inter & Above Notice Period :- Preferred Immediate Joiners WFO Perks and benefits Incentives Allowances 2 way Cab Interested candidates can share your updated resume to HR Dharani - 8341558673 mail id : dharanipalle.axishr@gmail.com (share resume via WhatsApp ) Refer your friend's / Colleague

Walk-In Drive on 7th June 2025 at Cotiviti -Pune for Healthcare Audit Walk-In Date: 7-June-2025 (Saturday) Time 9:00 Am 1:00 Pm Venue: Cotiviti India Pvt Ltd Plot C, Podium Floor, Binarius/Deepak Complex, Opposite Golf Course, Yerwada, Pune- 411006. We are hiring for the Healthcare Data Audit process at Cotiviti. Please refer to the information below and required skill set for the same. POSITION SUMMARY: Specialist Payment Accuracy position is an entry level position responsible for auditing client data and validating claim accuracy. Communicates audit recommendations and outcomes to supervisory auditor for evaluation, verification and continuous learning. POSITION REQUIREMENTS: Graduation mandatory. Excellent communication skills. US Healthcare experience is preferred. Computer proficiency in Microsoft Office (Word, Excel, Outlook); Access preferred Strong interest in working with large data sets and various databases Must be flexible working in fixed/rotational shifts Immediate joiners preferred Good energy and Positive attitude Long Term Career Orientation If the above profile interests you then please walk-in for the interview. Please refer to the above mentioned walk-in details. Please bring your updated Resume along with an ID Proof. Best regards, Atish Chintalwar Senior Executive Human Resource COTIVITI About Cotiviti: Cotiviti is a leading healthcare solutions and analytics company headquartered in the United States, with more than 10000 employees in offices across the U U.S., Canada, Australia, India, Nepal, Philippines & Mexico. Cotiviti has been in business for more than two decades (including predecessor companies), and our solutions have been well proven and tested. Our clients are primarily health insurance companies, including U.S. government payers, although healthcare providers, employers, and insurance brokers also use our solutions. In fact, we support almost every major health plan in the U.S. and more than 180 healthcare payers in total. We focus on improving the financial and quality performance of our clients. In healthcare, this means taking in billions of clinical and financial data points, analyzing them, and helping our clients discover ways they can improve efficiency and quality. In addition to healthcare, we support the largest and most influential retailers in the industry, including mass merchandisers, across the U.S., Canada, United Kingdom, Europe and Latin America. Our data management recovery audit services have helped them save hundreds of millions of dollars.

Preferred candidate profile Strong Knowledge in US Health Care domain in all lines of business especially Encounters, EDI, HIPAA compliance, 837 layout, CMS Medicare and Medicaid guidelines Knowledge of QNXT or other healthcare claims adjudication systems SQL Server SSIS and SSRS plus any Microsoft cloud technologies will be added advantage Analytical and query writing ability (SQL is a MUST) SQL procedure and packages debugging skills Knowledge on any reporting tools or software e.g. Tableau or Power BI etc US Night shifts WFO Team management required on papers TL-Upto 11 LPA TM- Upto 15 LPA For more details please connect on below Chhavi Bhatt 8955611211 Chhavi.bhatt@manningconsulting.in

Role Title: IT Project Management Associate Advisor - Integrated Solution Manager Position Summary: The Integrated Solutions Manager Associate Advisor will work with business, technology, and solution teams to develop artifacts that support the program’s overall long-term business objectives. This individual must possess a strong understanding of Cigna processes and capabilities across all integrated application/business work streams. & Responsibilities : Provides counsel and advice to top management on significant Integrated Solution matters, often requiring coordination between organizations. Responsible for managing, directing, and planning multiple complex projects, or occasionally one highly complex project, consisting of one or more project teams. Responsible for coordinating, scheduling, and assigning project tasks, team building, maintaining working relationships with client functional areas outside of IT. Applies project development methodologies and reporting techniques to indicate project status. May manage and direct one or more project teams of project managers, specialists, analysts, and programmers to meet complex project objectives. Reviews, evaluates, and formulates project plans, schedules, and budgets. Allocates staff and budget resources to meet changing corporate needs. Identifies and negotiates schedules, milestones and resources required to meet project objectives. Organizes and guides project operations using methodologies accepted by the industry. Evaluates and reports progress in terms of quality and performance metrics common to IT projects. Modifies schedules as required. Works with client departments to coordinate systems testing, installation, training, and support. Keeps informed of technical and managerial advances in IT. Focuses on providing thought leadership and technical expertise across multiple disciplines. Recognized internally as “the go-to person” for the most complex IT Project Management assignments. Work with the ISMs and system teams to plan technical Integrated, End-to-End and Regression Testing that aligns with the portfolio and program level epics. Participate in agile development and collaborate with developers and product managers to plan for testing. Leverage test management and execution tools including Jira and Zephyr. Oversee ISM work throughout test plan development and test execution to ensure that testing is on time and within budget. Measure and monitor progress and results during each test to ensure that the product is tested, validated, and demoed on time and within budget, and that it meets or exceeds expectations, including taking necessary corrective actions as needed. Ensure that the team follows the testing standards, guidelines, and testing methodology as agreed upon. Develop reusable automated test scripts and maintain their compatibility. Facilitate continuous improvement including identification and implementation of test automation. Be the first escalation point when issues arise within the integrated testing phase. Escalate to the Integration Solution Manager Practice Lead as necessary and appropriate if issues are unresolvable at their level. Ensure appropriate resources are assigned to projects with the right skillset and experience. Review test strategies for programs/projects to ensure they achieve the quality objectives that are defined. Serve as a subject matter expert in test management regardless of what methodology is used to execute. Communicate importance of and drive team’s compliance with Cigna policies and procedures. Manage oversight of ISM’s work activities and assignments throughout the integrated testing life cycle. Competencies / Skills: Strong technical test experience The ability to write a Program/Project Test Strategy and Program/Project Level Test Plan Deep understanding of technical requirements, portfolio, and program epics Ability to develop and manage all aspects of the technical testing effort, including plans, interdependencies, schedule, budget, tools, and required personnel. Good understanding of best testing practices and ability to provide feedback at technical reviews. Ability to document and communicate the status of testing progress against plans, taking corrective action as necessary. Ability to provide technical leadership to meet testing deadlines and objectives. Ability to review deliverables for completeness, quality, and compliance with established project standards. Expert level of Healthcare products, Commercial, Medicare/Medicaid Team Leadership & Development including ability to mentor, coach, and effectively transfer expertise to others. Ability to resolve conflict (striving for win-win outcomes); ability to execute with limited information and ambiguity. Ability to deal with organizational politics including ability to navigate a highly matrixed organization effectively. Strong Influencing skills (sound business and technical acumen as well as skilled at achieving buy-in for delivery strategies) Stakeholder management (setting and managing expectations) Strong business acumen including ability to effectively articulate business objectives. Analytical skills, Highly Focused, Team player, Versatile, Resourceful Ability to learn and apply quickly including ability to effectively impart knowledge to others. Effective under pressure Precise communication skills, including an ability to project clarity and precision in verbal and written communication and strong presentation skills. Strong problem-solving and critical thinking skills Experience Required: Experience providing mentoring/coaching to several individuals. Experience with managing vendor relationships. Experience with Agile delivery methodology. Qualified candidates will typically have 8 - 11 years of professional IT work experience and managing projects/initiatives. Experience Desired: Demonstrated experience establishing and delivering complex projects/initiatives within agreed upon parameters while achieving the benefits and/or value-added results. Demonstrated core project management skills including project planning, scope management, issue and risk management, resource planning, financial management, etc. Competencies: Manages Ambiguity Manages Conflict Collaborates Manages Complexity Resourcefulness Nimble Learning About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

Role Title: IT Project Management Lead Analyst - Integrated Solution Manager Position Summary: The Integrated Solution Manager Lead Analyst is responsible for defining and supporting the building of the integrated test strategies and test plans those alignments with the portfolio and program epic needs over the product lifecycle. This individual will work with business, technology, and solution teams to develop artifacts that supports the program overall long-term business objective. This individual must possess a strong understanding of Cigna processes and capabilities across all integrated application/business work streams. & Responsibilities : The ISM drives the testing phases and delivers artifacts in conjunction with the test execution phases. Collaborates with project team during the Project Kickoff, PI Prep, Execution Sync and Test evidence reviews. Leads Test Execution phases. Test Execution is a phase of Integration testing which is coordinated by the ISM in conjunction with other QE test teams in order to prove that the proposed technical solution for the business need has been met. The activities handled during this timeframe are: Work with system teams to plan technical Integrated, End-to-End and Regression Testing that aligns with the portfolio and program level epics. Participate in agile development and collaborate with developers and product managers to plan for testing. Leverage test management and execution tools including Jira and Zephyr. Measure and monitor progress and results during each test to ensure that the product is tested, validated, and demoed on time and within budget, and that it meets or exceeds expectations, including taking necessary corrective actions as needed. Ensure that the team follows the testing standards, guidelines, and testing methodology as agreed upon. Develop reusable automated test scripts and maintain their compatibility. Facilitate continuous improvement including identification and implementation of test automation. Be the first escalation point when issues arise within the integrated testing phase. Escalate to the Integration Solution Manager Practice Lead as necessary and appropriate if issues are unresolvable at their level. Create test strategies for programs/projects to ensure they achieve the quality objectives that are defined. Serve as a subject matter expert in test management regardless of what methodology is used to execute. Communicate importance of and drive team’s compliance with Cigna policies and procedures. Competencies / Skills: Strong technical test experience The ability to write a Program/Project Test Strategy and Program/Project Level Test Plan Deep understanding of technical requirements, portfolio, and program epics Ability to develop and manage all aspects of the technical testing effort, including plans, interdependencies, schedule, budget, tools, and required personnel. Good understanding of best testing practices and ability to provide feedback at technical reviews. Ability to document and communicate the status of testing progress against plans, taking corrective action as necessary. Ability to provide technical leadership to meet testing deadlines and objectives. Ability to review deliverables for completeness, quality, and compliance with established project standards. Expert level of Healthcare products, Commercial, Medicare/Medicaid Ability to resolve conflict (striving for win-win outcomes); ability to execute with limited information and ambiguity Ability to deal with organizational politics including ability to navigate a highly matrixed organization effectively. Strong Influencing skills (sound business and technical acumen as well as skilled at achieving buy-in for delivery strategies) Stakeholder management (setting and managing expectations) Strong business acumen including ability to effectively articulate business objectives. Analytical skills, Highly Focused, Team player, Versatile, Resourceful Ability to learn and apply quickly including ability to effectively impart knowledge to others. Effective under pressure Precise communication skills, including an ability to project clarity and precision in verbal and written communication and strong presentation skills. Strong problem-solving and critical thinking skills Experience Required: Qualified candidates will typically have 5 - 8 years of professional IT work experience and managing projects/initiatives. Experience Desired: Demonstrated experience establishing and delivering complex projects/initiatives within agreed upon parameters while achieving the benefits and/or value-added results. Demonstrated core project management skills including project planning, scope management, issue and risk management, resource planning, financial management, etc. Experience with Agile delivery methodology. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

Role Title: IT Project Management Senior Analyst - Integrated Solution Manager Position Summary: The Integrated Solution Manager Senior Analyst is responsible for defining and supporting the building of the integrated test strategies and test plans those alignments with the portfolio and program epic needs over the product lifecycle. This individual will work with business, technology, and solution teams to develop artifacts that supports the program overall long-term business objective. This individual must possess a strong understanding of Cigna processes and capabilities across all integrated application/business work streams. & Responsibilities : The ISM drives the testing phases and delivers artifacts in conjunction with the test execution phases. Collaborates with project team during the Project Kickoff, PI Prep, Execution Sync and Test evidence reviews. Leads Test Execution phases. Test Execution is a phase of Integration testing which is coordinated by the ISM in conjunction with other QE test teams in order to prove that the proposed technical solution for the business need has been met. The activities handled during this timeframe are: Work with system teams to plan technical Integrated, End-to-End and Regression Testing that aligns with the portfolio and program level epics. Participate in agile development and collaborate with developers and product managers to plan for testing. Leverage test management and execution tools including Jira and Zephyr. Measure and monitor progress and results during each test to ensure that the product is tested, validated, and demoed on time and within budget, and that it meets or exceeds expectations, including taking necessary corrective actions as needed. Ensure that the team follows the testing standards, guidelines, and testing methodology as agreed upon. Develop reusable automated test scripts and maintain their compatibility. Facilitate continuous improvement including identification and implementation of test automation. Be the first escalation point when issues arise within the integrated testing phase. Escalate to the Integration Solution Manager Practice Lead as necessary and appropriate if issues are unresolvable at their level. Create test strategies for programs/projects to ensure they achieve the quality objectives that are defined. Serve as a subject matter expert in test management regardless of what methodology is used to execute. Communicate importance of and drive team’s compliance with Cigna policies and procedures. Competencies / Skills: Strong technical test experience The ability to write a Program/Project Test Strategy and Program/Project Level Test Plan Deep understanding of technical requirements, portfolio, and program epics Ability to develop and manage all aspects of the technical testing effort, including plans, interdependencies, schedule, budget, tools, and required personnel. Good understanding of best testing practices and ability to provide feedback at technical reviews. Ability to document and communicate the status of testing progress against plans, taking corrective action as necessary. Ability to provide technical leadership to meet testing deadlines and objectives. Ability to review deliverables for completeness, quality, and compliance with established project standards. Expert level of Healthcare products, Commercial, Medicare/Medicaid Ability to resolve conflict (striving for win-win outcomes); ability to execute with limited information and ambiguity Ability to deal with organizational politics including ability to navigate a highly matrixed organization effectively. Strong Influencing skills (sound business and technical acumen as well as skilled at achieving buy-in for delivery strategies) Stakeholder management (setting and managing expectations) Strong business acumen including ability to effectively articulate business objectives. Analytical skills, Highly Focused, Team player, Versatile, Resourceful Ability to learn and apply quickly including ability to effectively impart knowledge to others. Effective under pressure Precise communication skills, including an ability to project clarity and precision in verbal and written communication and strong presentation skills. Strong problem-solving and critical thinking skills Experience Required: Qualified candidates will typically have 3 - 5 years of professional IT work experience and managing projects/initiatives. Experience Desired: Demonstrated experience establishing and delivering complex projects/initiatives within agreed upon parameters while achieving the benefits and/or value-added results. Demonstrated core project management skills including project planning, scope management, issue and risk management, resource planning, financial management, etc. Experience with Agile delivery methodology. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

Role TitleIT Project Management Advisor - Integrated Solution Manager Position Summary: The Integrated Solutions Manager Advisor will work with business, technology, and solution teams to develop artifacts that support the program’s overall long-term business objectives. This individual must possess a strong understanding of Cigna processes and capabilities across all integrated application/business work streams. & Responsibilities: Provides counsel and advice to top management on significant Integrated Solution matters, often requiring coordination between organizations. Responsible for managing, directing, and planning multiple complex projects, or occasionally one highly complex project, consisting of one or more project teams. Responsible for coordinating, scheduling, and assigning project tasks, team building, maintaining working relationships with client functional areas outside of IT. Applies project development methodologies and reporting techniques to indicate project status. May manage and direct one or more project teams of project managers, specialists, analysts, and programmers to meet complex project objectives. Reviews, evaluates, and formulates project plans, schedules, and budgets. Allocates staff and budget resources to meet changing corporate needs. Identifies and negotiates schedules, milestones and resources required to meet project objectives. Organizes and guides project operations using methodologies accepted by the industry. Evaluates and reports progress in terms of quality and performance metrics common to IT projects. Modifies schedules as required. Works with client departments to coordinate systems testing, installation, training, and support. Keeps informed of technical and managerial advances in IT. Focuses on providing thought leadership and technical expertise across multiple disciplines. Recognized internally as “the go-to person” for the most complex IT Project Management assignments. Work with the ISMs and system teams to plan technical Integrated, End-to-End and Regression Testing that aligns with the portfolio and program level epics. Participate in agile development and collaborate with developers and product managers to plan for testing. Leverage test management and execution tools including Jira and Zephyr. Oversee ISM work throughout test plan development and test execution to ensure that testing is on time and within budget. Measure and monitor progress and results during each test to ensure that the product is tested, validated, and demoed on time and within budget, and that it meets or exceeds expectations, including taking necessary corrective actions as needed. Ensure that the team follows the testing standards, guidelines, and testing methodology as agreed upon. Develop reusable automated test scripts and maintain their compatibility. Facilitate continuous improvement including identification and implementation of test automation. Be the first escalation point when issues arise within the integrated testing phase. Escalate to the Integration Solution Manager Practice Lead as necessary and appropriate if issues are unresolvable at their level. Ensure appropriate resources are assigned to projects with the right skillset and experience. Review test strategies for programs/projects to ensure they achieve the quality objectives that are defined. Serve as a subject matter expert in test management regardless of what methodology is used to execute. Communicate importance of and drive team’s compliance with Cigna policies and procedures. Manage oversight of ISM’s work activities and assignments throughout the integrated testing life cycle. Competencies / Skills: Strong technical test experience The ability to write a Program/Project Test Strategy and Program/Project Level Test Plan Deep understanding of technical requirements, portfolio, and program epics Ability to develop and manage all aspects of the technical testing effort, including plans, interdependencies, schedule, budget, tools, and required personnel. Good understanding of best testing practices and ability to provide feedback at technical reviews. Ability to document and communicate the status of testing progress against plans, taking corrective action as necessary. Ability to provide technical leadership to meet testing deadlines and objectives. Ability to review deliverables for completeness, quality, and compliance with established project standards. Expert level of Healthcare products, Commercial, Medicare/Medicaid Team Leadership & Development including ability to mentor, coach, and effectively transfer expertise to others. Ability to resolve conflict (striving for win-win outcomes); ability to execute with limited information and ambiguity. Ability to deal with organizational politics including ability to navigate a highly matrixed organization effectively. Strong Influencing skills (sound business and technical acumen as well as skilled at achieving buy-in for delivery strategies) Stakeholder management (setting and managing expectations) Strong business acumen including ability to effectively articulate business objectives. Analytical skills, Highly Focused, Team player, Versatile, Resourceful Ability to learn and apply quickly including ability to effectively impart knowledge to others. Effective under pressure Precise communication skills, including an ability to project clarity and precision in verbal and written communication and strong presentation skills. Strong problem-solving and critical thinking skills Experience Required: Experience providing mentoring/coaching to several individuals. Experience with managing vendor relationships. Experience with Agile delivery methodology. Qualified candidates will typically have 11 - 13 years of professional IT work experience and managing projects/initiatives. Experience Desired: Demonstrated experience establishing and delivering complex projects/initiatives within agreed upon parameters while achieving the benefits and/or value-added results. Demonstrated core project management skills including project planning, scope management, issue and risk management, resource planning, financial management, etc. Competencies: Manages Ambiguity Manages Conflict Collaborates Manages Complexity Resourcefulness Nimble Learning About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

Job Summary We are seeking a dedicated Senior Process Executive - HC with 1 to 3 years of experience in Claims Adjudication. The ideal candidate will have expertise in Medicare and Medicaid Claims and it is advantageous if they also have experience in Commercial Claims. This is a work-from-home position with night shifts. Responsibilities Process and adjudicate Medicare and Medicaid claims efficiently and accurately. Ensure compliance with all relevant regulations and guidelines. Analyze and resolve claim discrepancies and issues promptly. Collaborate with team members to improve claim processing workflows. Maintain up-to-date knowledge of industry standards and changes. Provide exceptional customer service to internal and external stakeholders. Utilize technical skills to enhance claims adjudication processes. Monitor and report on claim processing metrics and performance. Identify and implement process improvements to increase efficiency. Conduct regular audits to ensure accuracy and compliance. Train and mentor junior team members on claims adjudication processes. Communicate effectively with other departments to resolve claim issues. Participate in continuous learning and development opportunities. Qualifications Possess strong technical skills in claims adjudication. Have in-depth knowledge of Medicare and Medicaid claims. Experience in Commercial Claims is a plus. Demonstrate excellent analytical and problem-solving abilities. Exhibit strong attention to detail and accuracy. Show proficiency in relevant software and tools. Display effective communication and teamwork skills. Maintain a high level of professionalism and integrity. Be adaptable to night shifts and work-from-home model. Have a proactive approach to learning and development. Demonstrate the ability to work independently and manage time effectively. Show commitment to delivering high-quality work consistently. Possess a customer-focused mindset and dedication to service excellence.

Immediate Requirement Hospital Billing AR Caller / Sr. AR Caller Exp: 1 to 7yrs Salary: 42k Location: Bangalore Interested Candidate Plz Drop Updated CV to gayathri.srinivasan@geniehr.com or Ping me 7339094334

BA SQL Medicaid US Healthcare, Medicaid, Claims, SQL, QNXT, Facets Gather and analyze business requirements from stakeholders Document BRDs, FRDs, and user stories for development teams Facilitate communication between business and technical teams Conduct gap analysis and suggest improvements Support UAT, training, and deployment activities Create process flowcharts, data models, and presentations Track project progress and provide status updates to leadership

Role & responsibilities Accurately post all payments (electronic, checks, credit cards, etc.) to patient accounts in the billing system. Ensure all payments are applied to the correct accounts and invoices. Identify and resolve discrepancies between posted payments and actual deposits. Post adjustments, write-offs, and denials as per payer contracts and company policies. Identify trends in denials and underpayments and communicate findings to management. Identify billing errors and make necessary corrections to avoid claim denials. Ensure timely and accurate submission of claims to payers. Manage the resolution of denied claims by identifying root causes and correcting errors. Resubmit corrected claims to payers for reimbursement. Track and report on claim correction activities and outcomes. Ensure all billing and charge correction activities comply with relevant laws, regulations, and internal policies. Stay updated on changes in billing regulations and payer requirements. Preferred candidate profile Bachelors degree in business or accounting major is preferred. 1 to 6 years experience in healthcare insurance collections, accounts receivable management, billing and claims processing, and insurance payor contracts. Advanced knowledge of insurance contracting, payor regulations, insurance benefits, coordination of benefits, managed care, and healthcare compliance, rules, and regulations. Advanced experience with reading, and understanding medical policy information, and utilizing insurance benefit and coverage information to recovery denied claims. Experience with medical billing and collections terminology CPT, HCPCS, ICD-10 and NDC coding, HIPAA guidelines and healthcare compliance.

Job Summary We are seeking an experienced Architect with 12 to 15 years of experience to join our team. The ideal candidate will have strong technical skills in React JS and Java along with domain expertise in Medicare and Medicaid Claims Claims and Payer. This hybrid role requires a proactive individual who can drive technical solutions and contribute to the companys mission of improving healthcare systems. Responsibilities Lead the design and development of scalable and efficient software solutions using React JS and Java Oversee the implementation of technical solutions that align with business requirements and industry standards Provide technical guidance and mentorship to the development team to ensure best practices are followed Collaborate with cross-functional teams to gather and analyze requirements ensuring comprehensive understanding of project goals Develop and maintain technical documentation to support the development and deployment of software solutions Ensure the security performance and reliability of applications through rigorous testing and quality assurance processes Drive continuous improvement initiatives to enhance the development process and overall product quality Monitor and evaluate emerging technologies and industry trends to incorporate innovative solutions into the architecture Facilitate effective communication between stakeholders including business analysts project managers and developers Conduct code reviews to ensure adherence to coding standards and best practices Troubleshoot and resolve complex technical issues providing timely and effective solutions Contribute to the strategic planning and execution of technology roadmaps to support business objectives Ensure compliance with regulatory requirements and industry standards in all technical solutions Qualifications Possess a strong background in React JS and Java with proven experience in developing complex applications Demonstrate expertise in Medicare and Medicaid Claims Claims and Payer domains Exhibit excellent problem-solving skills and the ability to troubleshoot and resolve technical issues effectively Showcase strong communication and collaboration skills to work effectively with cross-functional teams Have a proactive approach to learning and staying updated with the latest industry trends and technologies Display a commitment to quality and a keen eye for detail in all aspects of software development Hold a bachelors degree in Computer Science Information Technology or a related field Preferably have a masters degree or relevant certifications in software architecture or related disciplines Show experience in leading and mentoring development teams to achieve project goals Demonstrate the ability to create and maintain comprehensive technical documentation Exhibit strong organizational skills and the ability to manage multiple tasks and projects simultaneously Have a solid understanding of regulatory requirements and industry standards in the healthcare domain Display a passion for improving healthcare systems and contributing to the companys mission.

Job Location : Hyderabad Qualification - Graduate Work mode Work from office Shift timing 1:00 PM IST to 12:00 AM IST Team leader - 12 lpa Team Manager - 15 lpa Notice 0-60 days US Health Care Domain Knowledge. E.g. Encounters, EDI, HIPAA, 837 Layout, insights into Medicare and Medicaid Markets etc. Facets 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. Best regards, Manish Chauhan HR Executive | Career Guideline Mumbai / Bangalore 9136520859 manish@careerguideline.co.in

Roles & Responsibilities: Follow up with the payer to check on claim status. Identify denial reason and work on resolution. Save claim from getting written off by timely following up. Should have sound knowledge of working on Billing scrubbers and making edits. Work on Contractual adjustments & write off projects. Should have good Cash collected/Resolution Rate. Should have calling skills, probing skills and denials understanding. Work in all shifts on a rotational basis. No Planned leaves for next 6 months Requirements: 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 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.

Essential Duties and Responsibilities: Must be on current role of team handling for minimum 1.5 years Great knowledge AR/Credit up or end-to-end knowledge Should be aware of all type of payers. Must have good understanding of payer portal for benefits & denials. Should have great verbal and written communication skills, probing skills and denials understanding Open for night shift and WFO No Planned leaves for next 6 months. 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 be good Healthcare knowledge. Candidate should have knowledge of Medicare, Medicaid & ICD & CPT codes used on Denials. Ability to interact positively with team members, peer group, seniors and onshore counterpart.

Roles & Responsibilities: Follow up with the payer to check on claim status. Identify denial reason and work on resolution. Save claim from getting written off by timely following up. Should have sound knowledge of working on Billing scrubbers and making edits. Work on Contractual adjustments & write off projects. Should have good Cash collected/Resolution Rate. Should have calling skills, probing skills and denials understanding. Work in all shifts on a rotational basis. No Planned leaves for next 6 months Requirements: 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 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. Working in an evolving healthcare setting, we use our shared expertise to deliver innovative solutions. Our fast-growing team has opportunities to learn and grow through rewarding interactions, collaboration and the freedom to explore professional interests.

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.

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: 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.

Responsibilities: * Manage denials through effective communication with providers and insurers. * Ensure compliance with HIPAA, Medicaid, Medicare, Cobra, ICD, CPT, HCPCS codes. Health insurance Office cab/shuttle Provident fund

Job Description The Provider Enrollment is responsible for the timely and accurate enrollment of healthcare providers with government and commercial insurance payers. This role ensures that providers are enrolled correctly and efficiently so that they can bill and receive reimbursement for services renders. The Specialist works closely with the Hospital system and payer organizations to facilitate smooth onboarding and maintain compliance with payer requirements. Role & responsibilities Prepare, submit, and track provider applications for enrollment and credentialing with Medicare, Medicaid, and commercial payers. Assist with creating and maintenance of CAQH profiles. Monitor and follow up on application statuses to ensure timely processing. Communicate with insurance companies and internal stakeholders to resolve issues related to enrollment. Maintain confidentiality and professionalism while performing work tasks. Track and Maintain work production daily. Preferred candidate profile 1-3 years of experience in provider enrollment, credentialing, or medical billing strongly preferred. Knowledge of CMS, Medicaid, and commercial payer enrollment processes. Familiarity with CAQH, NPPES, PECOS, and payer portals. Strong organizational skills and attention to detail Excellent written and verbal communication skills. Ability to manage multiple tasks and meet deadlines. Proficiency in Microsoft Office (Excel, Word, Outlook, Sharepoint) and experience navigating web-based applications Ability to work positively and productively in a fast-paced environment. Accurate typing of 40 WPM is required. Perks and Benefits: Night Shift Allowance Fixed week Offs (Sat-Sun) 2way cab facility (within 25 KM Radius) Incentives plan Walkin Details: Date: 2-May-2025- 25-May-2025 Timings: 11AM to 4PM Contact Person: HR Aishwarya/ 9032212019 Please share your resumes on the below mentioned Mail id: Pyaram.Aishwarya@sutherlandglobal.com Mention HR Aishwarya on your resume Venue: 7th Floor, Divyasree building, Lanco hills, Khajaguda, Manikonda.

#FOLLOW-UP WITH MEDICAL INSURANCE PAYERS REGARDING THE STATUS OF OUTSTANDING CLAIMS #PROFICIENT IN COMPLETING AND SENDING CLAIM FORMS ACCORDING TO UB04,CMS& THIRD-PARTY PAYER GUIDELINES #STRONG KNOWLEDGE OF END TO END DENIAL MANAGEMENT PROCESSES Required Candidate profile 1 TO 4 YEARS EXP. AR CALLING PROCESS(CMS1500)EXP. IN COMP. & SUB. CLAIM FORMS ACC. TO CMS & THIRD-PARTY PAYER GUIDELINES STRONG FOCUS ON SERVICE EXCELL. WHEN DEALING WITH PATIENTS,CLIENTS & COMP. EMP. Perks and benefits #BEST SALARY, INCENTIVE PLANS #VIRTUAL INTERVIEWS