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1 - 4 years
2 - 5 Lacs
Gurgaon
Work from Office
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. Non RCM (US Healthcare experience) candidates: BE/BTech pass-outs are not eligible and any experience above 2 years are not eligible Perks and Benefits: 5 days working Both side cabs (subject to hiring zone) Meal Health Insurance Chance to work in a Great Place to Work Certified Company (Winner for Three Consecutive Years) Interested and eligible candidates can call Namrata on 7059644807 to schedule an interview. Candidates can also come for Walk-Interview between 1-4 PM (entry time) at below mentioned address. Reference Name on CV - Namrata Lama (HR). Address : Tower 1, 2nd floor, Candor Techspa ce,Sector 48,Tikri , GURGAON, Haryana, India
Posted 2 months ago
1 - 6 years
1 - 4 Lacs
Chennai
Work from Office
Dear Aspirants, Warm Greetings!! We are hiring for the following details, Position: - AR Caller Salary: Based on Performance & Experienced Exp : Min 1 year Required Joining: Immediate Joiner / Maximum 10 days NB: Freshers do not apply Work from office only (Direct Walkins Only) Monday to Friday ( 5 pm to 8 Pm ) Everyday contact person Vineetha HR ( 9600082835 ) Interview time (5 pm to 8 Pm) Bring 2 updated resumes Refer( HR Name Vineetha vs) Mail Id : vineetha@novigoservices.com Call / Whatsapp (9600082835) Refer HR Vineetha Location : Chennai , Ekkattuthangal Warm Regards, HR Recruiter Vineetha VS Novigo Integrated Services Pvt Ltd,Sai Sadhan, 1st Floor, TS # 125, North Phase,SIDCOIndustrial Estate, Ekkattuthangal, Chennai 32 Contact details:- HR Vineetha vineetha@novigoservices.com Call / Whatsapp ( 9600082835)
Posted 2 months ago
1 - 6 years
2 - 6 Lacs
Navi Mumbai
Work from Office
#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
Posted 2 months ago
5 - 10 years
7 - 12 Lacs
Chennai
Work from Office
Project Role : Application Lead Project Role Description : Lead the effort to design, build and configure applications, acting as the primary point of contact. Must have skills : Electronic Medical Records (EMR) Good to have skills : NA Minimum 5 year(s) of experience is required Educational Qualification : 15 years full time education Summary :As an Application Lead, you will lead the effort to design, build, and configure applications, acting as the primary point of contact. You will be responsible for managing the team and ensuring successful project delivery. Your typical day will involve collaborating with multiple teams, making key decisions, and providing solutions to problems for your immediate team and across multiple teams. Key Responsibilities1 Part of a development team working on Regulatory reporting in a US Health Care 2 Responsible for closely working with Client in Requirements Gathering, designing, optimizing/automating, story telling of data, and integration with different Health care programmes / products 3 knowledge on the process of adhering to laws, regulations, standards, and other rules set forth by governments and other regulatory bodies Technical Experience1 Must have:USA Medicaid or Medicare programs / Reporting , USA Health Care domain working with Encounter / Claims data 2 Must to have :Programming in python, SAS, writing and debugging complex SQL codes.3 Must to have :U.S. Health care regulations (eg. FDA Regulations, HIPAA).4 Good to have :Experience membership claims billing diagnosis codes , Healthcare Effectiveness Data and Information Set(HEDIS ) experience , Whole Child Model (WCM) program experience, Databricks Professional Attributes1 Requires strong problem solving and communication skills to interpret issues and provide resolution.2 Excellent Team player and exceptional abilities to work well in both the Team and Individual Educational Qualification1 minimum 15 years of full-time -education Additional Information: The candidate should have a minimum of 5 years of experience in Electronic Medical Records (EMR) This position is based at our Chennai office A 15 years full-time education is required 2 hrs PST overlap (available between 8 a.m. 10 a.m PST) Qualifications 15 years full time education
Posted 2 months ago
4 - 8 years
6 - 10 Lacs
Noida
Work from Office
Reports to (level of category) : Senior Operations Manager Role Objective Follow up is the most essential part in the RCM cycle. It is usually the last step in the cycle after cash posting. 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. a) Day-to-day operations b) People Management (Work Allocation, On job support, Feedback & Team building) c) Performance Management (Productivity, Quality, One-On-One sessions, KRA, PIP) d) Reports (Internal and Client performance reports) e) Work allocation strategy f) CMS 1500 & UB04 AR experience is mandatory. g) Span of control - 80 to 100 h) Thorough knowledge of all AR scenarios and Denials i) Expertise in both Federal and Commercial payor mix j) Excellent interpersonal skills h) Should be capable to interact with US clients and manage escalations 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 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. Demonstrated ability to exceed performance targets. Ability to effectively prioritize individual and team responsibilities. Communicates well in front of groups, both large and small. 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.
Posted 2 months ago
1 - 4 years
3 - 7 Lacs
Chennai
Work from Office
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.
Posted 2 months ago
1 - 4 years
2 - 5 Lacs
Bengaluru
Work from Office
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.
Posted 2 months ago
6 - 10 years
10 - 18 Lacs
Chennai
Work from Office
Summary As a Senior Project Manager at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve a communitys most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcares biggest challenges. Here are the details on this position. Your role in our mission Strengthen the quality and smooth running of important projects as we create innovative, purpose-built technologies and solutions for our company and clients. Lead one or more medium-sized project management teams by overseeing smaller aspects of a larger technological program Go all in as you contribute directly to projects, assist in staffing and overseeing assigned staff by providing direction and deadlines to ensure quality and the timely completion of tasks Interface with the client, company and project team leadership, measuring and communicating project metrics and recommending program changes as needed Drive the quality of project deliverables across all phases of the program by creating objectives, schedules, program definitions and budgets Help ensure project timeliness and quality by identifying and mitigating risk through status reporting and project updates Prepare detailed SOW for clients and obtain agreement and approval from stakeholders on the scope of that work What we're looking for 6 years or more experience managing complex projects, programs or initiatives through a full project management life cycle, with 3 or more years of Medicaid and Medicare experience preferred Strong knowledge in project management methodology such as Certified Project Management Professional (PMP) Modern understanding of budget development, control and assurance methods, and project management software Ability to translate broader program objectives of a program into clear and achievable project milestones Leadership to train, guide and mentor the work of junior colleagues Strong executive presenter who communicates ideas clearly Creative problem-solver who thrives on defining structure from ambiguity
Posted 2 months ago
7 - 11 years
3 - 7 Lacs
Navi Mumbai
Work from Office
Skill required: Operations Support - Pharmacy Benefits Management (PBM) Designation: Service Delivery Ops Specialist Qualifications: Any Graduation Years of Experience: 7 to 11 years What would you do? Embedding digital transformation in healthcare operations end-to-end, driving superior outcomes and value realization today, and enabling streamlined operations to serve the emerging health care market of tomorrowYou will be a part of the Healthcare Claims team which is responsible for the administration of health claims. This team is involved in core claim processing such as registering claims, editing & verification, claims evaluation, and examination & litigation.The business processes, operations and interactions of third party administrators of prescription drug programs, understanding of the processes used to manage programs for payers, process and pay prescription drug claims, develop and maintain the formulary, contract with pharmacies and negotiate discounts and rebates with drug manufacturers. What are we looking for? Adaptable and flexible Ability to perform under pressure Problem-solving skills Results orientation Ability to establish strong client relationship Roles and Responsibilities: In this role you are required to do analysis and solving of moderately complex problems May create new solutions, leveraging and, where needed, adapting existing methods and procedures The person would require understanding of the strategic direction set by senior management as it relates to team goals Primary upward interaction is with direct supervisor May interact with peers and/or management levels at a client and/or within Accenture Guidance would be provided when determining methods and procedures on new assignments Decisions made by you will often impact the team in which they reside Individual would manage small teams and/or work efforts (if in an individual contributor role) at a client or within Accenture Please note that this role may require you to work in rotational shifts
Posted 2 months ago
6 - 10 years
8 - 12 Lacs
Bengaluru
Work from Office
Summary As a C/Pro*C Developer (Pro*C,SQL,Unix) at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve a communitys most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcares biggest challenges. Here are the details on this position. Your role in our mission Design your career for growth, new possibilities and refining your valuable skills: Head up workstreams to design, develop, test and install complex applications software that spans server, client and web components Help guide closer connections between application architects and developers to ensure design requirements are accurate and deliver a solid ROI for clients Show your skill at writing highly complex design, coding and testing documentation to create a technical product that meets client expectations Perform vital development, domain, application design, web service and database methodologies, and best practices provided by the project advisor and/or architect Serve as a technical consultant to senior management for complex projects from modifying existing apps to designing new application modules and components What we're looking for Six or more years of application, web and product design and support experience across the development life cycle, with experience preferred working with Medicaid and Medicare technologies A strong foundation in software and product design methodologies, programming languages, operating systems, web development and application implementation across the development life cycle Expertise in application development policies and procedures; and analyzing costing/ and budgets to determine financial feasibility A skilled designer and programming programmer who is effective across programming languages and environments as needed A demonstrated team player with the written and oral communication skills to be effective across application developers, clients and leadership
Posted 2 months ago
1 - 6 years
0 - 3 Lacs
Chennai
Work from Office
Greetings from Legacy Med Pvt Ltd We are the leading Revenue Cycle Management Company We are hiring for AR Callers & SR. AR Callers for Chennai Location Job profile : Verify patient insurance coverage and eligibility with insurance providers. Document and update patients' insurance and demographic information accurately. Communicate effectively with patients, providers, and insurance companies to resolve eligibility issues. Review and interpret insurance policy details to determine coverage applicability. Coordinate with billing and coding departments to ensure accurate claim submissions. Handle pre-authorizations and pre-certifications as required by insurance policies. Maintain up-to-date knowledge of insurance regulations and industry standards. Experience: A Candidate should have a minimum of 1 Year of Strong Experience in the Verification of Benefits & Eligibility Verification working with a leading Medical billing company Immediate Joiners Preferred Benefits: Pick up and Drop Transport Allowance Night meal pass ( Sodexo ) Referral Bonus Attendance Bonus Ready To Relocate Interested candidates can call or WhatsApp Vignesh - 8939118694 / Vignesh.munuswamy@legacyhealthllc.com
Posted 2 months ago
2 - 7 years
3 - 6 Lacs
Chennai
Hybrid
Responsibilities: Manage Medicare credentialing and provider enrollment through PECOS . Verify and submit provider applications for Medicare, Medicaid, and private payers. Maintain and update CAQH profiles , ensuring accuracy and timely attestation. Track application status and follow up with payers until final approval. Communicate with insurance companies, Medicare Administrative Contractors (MACs), and regulatory bodies to ensure smooth enrollment. Ensure compliance with CMS regulations , payer policies, and healthcare credentialing standards. Must-Have Qualifications: 2+ years of experience in provider credentialing & payer enrollment (preferably with Medicare). Proficiency in PECOS , CAQH, and payer-specific enrollment portals. Strong understanding of Medicare and Medicaid enrollment processes . Excellent communication and follow-up skills . Ability to work in a hybrid work arrangement .
Posted 2 months ago
1 - 4 years
3 - 5 Lacs
Chennai
Work from Office
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.
Posted 2 months ago
2 - 5 years
3 - 6 Lacs
Gurgaon
Work from Office
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.
Posted 2 months ago
1 - 4 years
2 - 6 Lacs
Noida
Work from Office
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.
Posted 2 months ago
0 - 1 years
1 - 2 Lacs
Gurgaon
Work from Office
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.
Posted 2 months ago
2 - 4 years
3 - 6 Lacs
Gurgaon
Work from Office
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.
Posted 2 months ago
3 - 8 years
6 - 10 Lacs
Chennai
Work from Office
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.
Posted 2 months ago
2 - 5 years
3 - 7 Lacs
Gurgaon
Work from Office
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.
Posted 2 months ago
18 - 22 years
20 - 25 Lacs
Bengaluru
Work from Office
Summary Your role in our mission Skills and Competencies: Regulatory Knowledge : Familiarity with US pharmacy & Drug rebate domain, prior authorization processes , Medicaid regulations, including DUR & formulary management Technology Proficiency : Proficiency with pharmacy management systems and electronic health records (EHR) Clinical Expertise : Strong clinical knowledge, including drug therapy management and patient counseling Communication : Excellent verbal and written communication skills What we're looking for Education and Experience Doctor of Pharmacy (PharmD) or Bachelors Degree in Pharmacy (B.Pharm) required State Pharmacist License : Active, unrestricted license to practice pharmacy in any state. Preferable not mandatory. Experience : Total years of exp. Should be 18+ years and 10+ years of experience in a clinical pharmacy setting, preferably with US Medicaid/Medicare What you should expect in this role Client or office environment / may work remotely Occasional evening and weekend work
Posted 2 months ago
4 - 9 years
1 - 6 Lacs
Chennai, Bengaluru
Work from Office
Job Summary : We are seeking a highly skilled and experienced Configuration Analyst to join our team. The ideal candidate will have extensive knowledge of Healthcare Payer operations and a strong experience in developing and delivering configuration on Claims platforms like Core Admin platforms. This role is essential for ensuring that our staff are well-trained and knowledgeable about industry standards, processes, and best practices. Minimum Required Skills and Qualifications: Minimum of 3+ years of experience in Configuration on either HealthRules Payer or Facets or QNXT is required (US Health insurance). Proven experience with configuration for Medicare, Medicaid, Commercial, and Individual-Exchange lines of business. Experience with HealthEdge HealthRules Payer (HRP) configuration would be preferred Experience with HealthEdge Source (Burgess) or HealthEdge GuidingCare would be added advantage. If interested kindly share your CV to deepalakshmi.rrr@firstsource.com / 8637451071
Posted 2 months ago
1 - 2 years
2 - 3 Lacs
Mumbai Suburbs, Mumbai (All Areas)
Work from Office
Experience - 2-3 years of experience in relevant payment posting (ERA Posting, Lockbox Posting, OTC Payments, Credit Balance Review, Statements Review/Release, Refunds) is mandate should have in-depth knowledge in all payer guidelines and COB codes pertinent to payment posting Should be well-versed with Gov-plans and Non-Gov Plans Having knowledge charge posting is added advantage kills: Typing speed 60 to 80 wpm, good written and oral communication, Able to work under pressure and deliver expected daily productivity targets. Ability to work with speed and accuracy Should have willingness to work over the weekends Job Responsibilities Production process Delivering the required quality & TAT Quality check on final files Updating the production reports Desired Qualities Behavior: Discipline, Positive Attitude & Punctuality. Flexible to work in any shift & weekends. Knowledge: Basic knowledge of computers & Data entry.
Posted 2 months ago
3 - 5 years
5 - 8 Lacs
Chennai
Work from Office
Essential Job Functions Assists in planning and designing business processes; assists in formulating recommendations to improve and support business activities. Assists in analyzing and documenting client's business requirements and processes; communicates these requirements to technical personnel by constructing basic conceptual data and process models, including data dictionaries and volume estimates. Assists in creating basic test scenarios to be used in testing the business applications in order to verify that client requirements are incorporated into the system design. Assists in developing and modifying systems requirements documentation to meet client needs. Participates in meetings with clients to gather and document requirements and explore potential solutions. Executes systems tests from existing test plans. Assists in analyzing test results in various phases. Participates in technical reviews and inspections to verify 'intent of change' is carried through phase of project. What we're looking for Basic Qualifications 3+ years of experience in Business Analyst, Provider, Claims adjudication, Medicaid or Medicare, SQL. 3+ years of business functional experience in one or more areas such as Eligibility, Claims, Provider. Strong SQL knowledge. Ability to write complex queries. Ability to gather requirements effectively; document requirements and confirm observations with business owners. Also, to perform fit/gap analysis based on requirements. Experience using Microsoft Office Tools, specifically Excel. Ability to create detailed and thorough design documents and test plans/execution for medium to large initiatives. Being able to research, analyze, validate and document business requirements.
Posted 2 months ago
7 - 11 years
9 - 14 Lacs
Navi Mumbai
Work from Office
Skill required: Operations Support - Pharmacy Benefits Management (PBM) Designation: Service Delivery Ops Specialist Qualifications: Any Graduation Years of Experience: 7 to 11 years What would you do? Embedding digital transformation in healthcare operations end-to-end, driving superior outcomes and value realization today, and enabling streamlined operations to serve the emerging health care market of tomorrowYou will be a part of the Pharmacy Benefit Management Team which is responsible for the administration of US healthcare. The business processes, operations and interactions of third party administrators of prescription drug programs, understanding of the processes used to manage programs for payers, process and pay prescription drug claims, develop and maintain the formulary, contract with pharmacies and negotiate discounts and rebates with drug manufacturers. What are we looking for? Adaptable and flexible Ability to perform under pressure Problem-solving skills Results orientation Ability to establish strong client relationship Business Operation Management Healthcare Management Pharmacy Benefit Management Roles and Responsibilities: In this role you are required to do analysis and solving of moderately complex problems May create new solutions, leveraging and, where needed, adapting existing methods and procedures The person would require understanding of the strategic direction set by senior management as it relates to team goals Primary upward interaction is with direct supervisor May interact with peers and/or management levels at a client and/or within Accenture Guidance would be provided when determining methods and procedures on new assignments Decisions made by you will often impact the team in which they reside Individual would manage small teams and/or work efforts (if in an individual contributor role) at a client or within Accenture Please note that this role may require you to work in rotational shifts Qualifications Any Graduation
Posted 2 months ago
2 - 3 years
3 - 7 Lacs
Chennai
Work from Office
Proficient in E/M coding Updated on Televisit codes Experienced in rejections Familiar with Medicare/UHC Knowledge of provider, dietician, and coach codes Expertise in Endo, OB/GYN, Cardio Proficient in CCM, RPM, PCM, PT, and Obesity codes Required Candidate profile Certified Professional Coder (CPC) or equivalent. 2-3 years of experience in E/M and specialty coding. Knowledge of Televisit and payer guidelines Experienced in rejections and corrections
Posted 2 months ago
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