126 Medicare Jobs - Page 2

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 an experienced Architect with 12 to 16 years of experience to join our team. The ideal candidate will have strong technical skills in Spring Boot Microservices and Java along with domain expertise in Medicare & Medicaid Claims Claims and Payer. This hybrid role requires a deep understanding of the healthcare industry and the ability to design and implement robust solutions. Responsibilities Lead the design and development of scalable and efficient software solutions using Spring Boot and Microservices. Oversee the implementation of Java-based applications to ensure high performance and responsiveness. Provide technical guidance and mentorship to the development team to ensure best practices are followed. Collaborate with stakeholders to gather and analyze requirements ensuring alignment with business objectives. Develop and maintain comprehensive documentation for all architectural designs and implementations. Ensure the security and compliance of software solutions with industry standards and regulations. Conduct code reviews and provide constructive feedback to improve code quality and maintainability. Troubleshoot and resolve complex technical issues in a timely manner to minimize downtime and impact. Stay updated with the latest industry trends and technologies to continuously improve the architecture. Work closely with the project management team to ensure timely delivery of projects within budget. Participate in the evaluation and selection of new tools and technologies to enhance the development process. Drive continuous improvement initiatives to optimize system performance and reliability. Engage with cross-functional teams to ensure seamless integration of software solutions. Qualifications Possess strong technical expertise in Spring Boot Microservices and Java. Have extensive experience in the healthcare domain specifically in Medicare & Medicaid Claims Claims and Payer. Demonstrate excellent problem-solving skills and the ability to think critically. Exhibit strong communication and interpersonal skills to effectively collaborate with team members and stakeholders. Show a proven track record of delivering high-quality software solutions on time and within budget. Have a deep understanding of software development lifecycle and agile methodologies. Be proficient in creating and maintaining technical documentation. Display a commitment to continuous learning and professional development. Have a strong attention to detail and a focus on delivering high-quality work. Be able to work independently and as part of a team in a hybrid work model. Show adaptability and flexibility in a dynamic work environment. Demonstrate a proactive approach to identifying and addressing potential issues. Possess a strong understanding of security and compliance requirements in the healthcare industry.

The AR Associate is responsible for the accounts receivable aspects of the client-focused revenue cycle operations and must display in-depth knowledge of and execute all standard operating procedures (SOPs) as well as communicating issues, trends, concerns and suggestions to leadership. Eligibility: Graduate with Minimum 1- 3 Years experience in Hospital Billing-Denial Management (RCM/AR Domain) & EPIC platform experience is an added advantage! Primary Responsibilities: Review outstanding insurance balances to identify and resolve issues preventing finalization of claim payment, including coordinating with payers, patients and clients when appropriate Analyze and trend data, recommending solutions to improve first pass denial rates and reduce age of overall AR Accounts Receivable Specialist that has an "understanding" of the whole accounting cycle / claim life cycle Ensure all workflow items are completed within the set turn-around-time within quality expectations Able to analyze EOBs and denials at a claim level in addition they should find trends impacting dollar and leading to process improvements Perform other duties as assigned Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so Role & responsibilities Must be a Graduate (10+2+3) Minimum 1-3 Years experience in Healthcare accounts receivable with (Denial Management) -Hospital Billing UB04 Solid knowledge of medical insurance (HMO, PPO, Medicare, Medicaid, Private Payers) In-depth working knowledge of the various applications associated with the workflows Must possess proven experience in Hospital Billing-UB04 If you are passionate about healthcare and meet the required criteria, we encourage you to attend and share this opportunity with your friends or colleagues who might be interested. Knowledge / Skills / Abilities: Solid knowledge and use of the American English language skills with neutral accent Ability to communicate effectively with all internal and external clients Ability to use good judgment and critical thinking skills; ability to identify and resolve problems Proficient in MS Office software; particularly Excel and Outlook Efficient and accurate keyboard/typing skills Solid work ethic and a high level of professionalism with a commitment to client/patient satisfaction Functional knowledge of HIPAA rules and regulations and experience related to privacy laws, access and release of information Interview Venue: Optum (UnitedHealth Group) aVance; Phoenix Infocity Private Ltd, SEZ 3rd floor, Site-5; Building No. H06A HITEC City 2, Hyderabad-500081 Date: 29-May-2025 Time: 11:00 AM Point Of Contact: Lakshmi Deshapaka Email: deshapaka_vijayalakshmi1@optum.com Things to Carry: Updated resume Government-issued photo ID (e.g., Aadhaar, Passport, or Driver's License) Passport-size photographs (2) Looking forward to seeing you and your referrals at the drive! Please Note: Dress Code: Business Formals Entry will be allowed only after showing the physical copy of this interview invite Kindly Ignore if you have appeared for a walk-in drive with us in the last 30 Days & not open to night shifts If you have no experience in Hospital Billing-UB04

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.

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together Primary Responsibilities The coder will evaluate medical records to verify the plan of care for chronic medical conditions The coder will perform accurate and timely coding review and validation of Hierarchical Condition Categories (HCCs) and Diagnoses through medical records. The coder will document ICD-10-CM codes to verify that coding meets both established coding standards as well as CMS Risk Adjustment Guidelines The coder will assist the project teams by completing review of all charts in line with Medicare & Medicaid Risk Adjustment criteria Apply understanding of anatomy and physiology to interpret clinical documentation and identify applicable medical codes Verify and ensure the accuracy, completeness, specificity and appropriateness of diagnosis codes based on services rendered Evaluate medical record documentation to ensure coding accurately reflects and supports relevant coding based on the ICD-10 code submitted to CMS for reimbursement and interpretation of medical documentation to ensure capture of all relevant coding based on CMS Hierarchical Condition Categories (HCC)conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives Demonstrate analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information Meet the production targets Meet the Quality parameters as defined by the Client SLA Other duties as assigned by supervisors. Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so Full-timeYes Work from officeYes Travelling Onsite / OffsiteNo Required Qualifications Any graduate experience Graduates in Medical, Paramedical or Life Science disciplines are preferred. Graduates from other disciplines may be considered subject to their ability to demonstrate technical competence in ICD-10 CM and risk adjustment guidelines and standards AAPC/AHIMA Certification is mandatory (CRC is most preferred followed by CPC, CIC or COC) or AHIMA-CCS certified Work experience of 1+ years Medical coding work experience of a minimum of 1 year is required. HCC coding work experience is highly preferred. Experience in other medical coding work experience can be considered provided they demonstrate technical competence in ICD-10 CM and risk adjustment guidelines and standards Good knowledge in Anatomy, Physiology & Medical terminology At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone - of every race, gender, sexuality, age, location and income - deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

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

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.

Follow up with payers to obtain claim status updates Identify reasons for denials and work towards resolution Must have Voice Experience Work on billing scrubbers and make necessary edits Handle contractual WhatsApp cv 7696517849 Required Candidate profile AR Caller With Experience for Hyderabad, Bangalore Night Shifts Cab Yes Excellent English Speaking WhatsApp cv 7696517849 Register For Call Back https://callcenterjobs.anejabusinessgroup.com/ Perks and benefits https://callcenterjobs.anejabusinessgroup.com/

HIRING - AR Callers ( PB & HB ) || Hyderabad, Chennai & Mumbai || Up to 40K Take home Experience :- Min 1 year of experience into AR Calling Package :- Up to 40K Take home Locations :- Hyderabad , Chennai & Mumbai Qualification :- Inter & Above Notice Period :- Preferred Immediate Joiners WFO HIRING - Payment Posting || Hyderabad || Up to 5 lpa Experience - Minimum 1.7 year (19 months ) of experience into Payment Posting Package - Upto 5lpa Location - Hyderabad Qualification: Graduation Notice Period - Preferred Immediate Joiners WFO HIRING - Pre Auth || Location :- Mumbai || Up to 4.6 LPA Experience :- Min 1 year of experience into Pre Auth Package :- Up to 4.6 LPA Locations :- Mumbai Qualification :- Graduate Notice Period :- Preferred Immediate Joiners - 2 months of notice WFO Perks and Benefits : Incentives Cab Facility Interested candidates can share your updated resume to HR Harshitha - 7207444236 (share resume via WhatsApp ) harshithaaxis5@gmail.com Refer your friend's / Colleagues

Follow up with payers to obtain claim status updates Identify reasons for denials and work towards resolution Must have Voice Experience Work on billing scrubbers and make necessary edits Handle contractual WhatsApp cv 7696517849 Required Candidate profile AR Caller With Experience for Hyderabad, Bangalore Night Shifts Cab Yes Excellent English Speaking WhatsApp cv 7696517849 Register For Call Back https://callcenterjobs.anejabusinessgroup.com/ Perks and benefits https://callcenterjobs.anejabusinessgroup.com/

MEDICAL CODER / MEDICAL BILLER Job Description We are looking for a detail-oriented and proactive Eligibility Executive to manage insurance verification and benefits validation for patients in the revenue cycle process. The ideal candidate will have experience working with U.S. healthcare insurance systems, payer portals, and EHR platforms to ensure accurate eligibility checks and timely updates for claims processing. Key Responsibilities Verify patient insurance coverage and benefits through payer portals, IVR, or direct calls to insurance companies. Update and confirm insurance details in the practice management system or EHR platforms accurately and in a timely manner. Identify policy limitations, deductibles, co-pays, and co-insurance information and document clearly for billing teams. Coordinate with patients and internal teams (billing, front desk, scheduling) to clarify eligibility-related concerns. Perform eligibility checks for scheduled appointments, procedures, and recurring services. Handle real-time and batch eligibility verifications for various insurance types including commercial, Medicaid, Medicare, and TPA. Escalate discrepancies or inactive coverage to the concerned team and assist in resolving issues before claim submission. Maintain up-to-date knowledge of payer guidelines and insurance plan policies. Ensure strict adherence to HIPAA guidelines and maintain confidentiality of patient data. Meet assigned productivity and accuracy targets while following internal SOPs and compliance standards. Preferred Skills & Tools Experience with EHR/PM systems like eCW, NextGen, Athena, CMD Familiarity with major U.S. insurance carriers and payer portals Strong verbal and written communication skills Basic knowledge of medical billing and coding is a plus Ability to work in a fast-paced, detail-focused environment Qualifications ANY LIFE SCIENCE DEGREE BSc, MSc, B.Pharm, M.Pharm, BPT NOTE CPC certification preferable

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

We are seeking a Lead Business Analyst / Product Manager (Director of Execution) to define, drive, and deliver product innovation across our AI-driven analytics and risk adjustment platform. This is a high-impact hybrid role combining business analysis, product strategy, and project execution, ideal for a results-oriented professional with deep experience in US healthcare technology, product lifecycle management, and stakeholder engagement. You will act as the strategic link between engineering, clinical, and client teams, ensuring timely execution of product roadmaps and aligning delivery with market needs, client feedback, and organizational priorities. This position is critical in translating clinical-AI capabilities into scalable, usable features that improve care quality and revenue outcomes for our clients.

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: 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 : 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.