Medical Claims Review Senior Analyst/Medical Advisor

1 - 4 years

15 - 18 Lacs

Posted:3 days ago| Platform: Foundit logo

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Work Mode

On-site

Job Type

Full Time

Job Description

Responsibilities:

  • Evaluates medical information against criteria, benefit plan, coverage policies and determines necessity for procedure and refers to Medical Director if criteria are not met
  • Evaluate itemized bills against reimbursement policies
  • Adheres to quality assurance standards
  • Serves as a resource to facilitate understanding of products
  • Handles some escalated cases; secures supervisory assistance with problem solving and decision making
  • Advises supervisory staff of any concerns or complaints expressed by Health Care Professionals
  • Utilizes effective communication, courtesy and professionalism in all interactions, both internally and externally
  • Analyze clinical information
  • Perform claim reviews with focus on coding and billing errors
  • Identify and refer cases for possible fraud/abuse or questionable billing practices to the appropriate matrix partners
  • Handle multiple products and benefit plans
  • Works under moderate direct supervision

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