5.0 - 9.0 years

0 Lacs

hyderabad, telangana

On-site

Role Overview: Zelis India is on a mission to enhance the healthcare financial experience and you will play a crucial role in this by supporting various initiatives. You will be responsible for performing comprehensive inpatient DRG validation Quality Assurance reviews to ensure accuracy of the DRG billed, managing claims, serving as a Subject Matter Expert on DRG validation, and identifying new DRG coding concepts to expand the DRG product. Your role will involve implementing and conducting quality assurance programs, preparing and conducting training for new team members, and recommending efficiencies and process improvements. Key Responsibilities: - Perform comprehensive inpatient DRG val...

Posted 2 days ago

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Dispute Resolution II Zelis

5.0 - 9.0 years

0 Lacs

hyderabad, telangana

On-site

Role Overview: You will be responsible for reviewing provider disputes related to DRG Coding and Clinical Validation, Itemized Bill Review, and Clinical Chart Review. Your main tasks will include analyzing disputes, providing explanations based on findings, managing claim dispute volume, and ensuring adherence to client turnaround times and department procedures. Additionally, you will serve as a subject matter expert for the Expert Claim Review Team, creating educational materials, conducting research, and maintaining bill review content. Key Responsibilities: - Review provider disputes for DRG Coding and Clinical Validation, Itemized Bill Review, and Clinical Chart Review - Submit explanat...

Posted 1 week ago

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Inpatient DRG Sr Reviewer Zelis

5.0 - 9.0 years

0 Lacs

hyderabad, telangana

On-site

About Us At Zelis India, our mission is to enhance the healthcare financial experience by developing and implementing innovative solutions. We are dedicated to optimizing technology and processes for efficiency and effectiveness. Our collaborative work culture, leadership development initiatives, and global exposure opportunities create a dynamic environment for professional growth. With hybrid work flexibility, comprehensive healthcare benefits, financial wellness programs, and cultural celebrations, we strive to provide a holistic workplace experience. Our team at Zelis India maintains high standards of service delivery and contributes to our award-winning culture. Position Overview As a m...

Posted 2 months ago

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Dispute Resolution II Zelis

5.0 - 9.0 years

0 Lacs

hyderabad, telangana

On-site

As a Provider Dispute Specialist at our organization, you will play a crucial role in reviewing provider disputes related to DRG Coding and Clinical Validation, Itemized Bill Review, and Clinical Chart Review. Your responsibilities will include submitting explanations of dispute rationale back to providers within the designated timeframe to ensure client turnaround times are met. You will be accountable for managing claim dispute volume on a daily basis, adhering to client turnaround time, and department Standard Operating Procedures. In this role, you will serve as a subject matter expert for the Expert Claim Review Team, providing support on day-to-day activities, troubleshooting, and ensu...

Posted 2 months ago

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US Medicare Selcoulth World Pvt Ltd.

1.0 - 5.0 years

0 Lacs

noida, uttar pradesh

On-site

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 eligi...

Posted 3 months ago

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