126 Medicare Jobs - Page 5

Skill required: Operations Support - Pharmacy Benefits Management (PBM) Designation: Health Operations Associate Qualifications: Any Graduation Years of Experience: 1 to 3 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? Ability to establish strong client relationship Ability to handle disputes Ability to manage multiple stakeholders Ability to meet deadlines Ability to perform under pressure Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your expected interactions are within your own team and direct supervisor You will be provided detailed to moderate level of instruction on daily work tasks and detailed instruction on new assignments The decisions that you make would impact your own work You will be an individual contributor as a part of a team, with a predetermined, focused scope of work Please note that this role may require you to work in rotational shifts Qualifications Any Graduation

Skill required: Operations Support - Pharmacy Benefits Management (PBM) Designation: Health Operations New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 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 solve routine problems, largely through precedent and referral to general guidelines Your primary interaction is within your own team and your direct supervisor In this role you will be given detailed instructions on all tasks The decisions that you make impact your own work and are closely supervised You will be an individual contributor as a part of a team with a predetermined, narrow scope of work Please note that this role may require you to work in rotational shifts Qualifications Any Graduation

Expertise in Payer ecosystem -- Enrollment & Premium Billing, Medicare, 834 files Technical understanding of Data models along Healthcare Applications – Preferably QNXT SQL – Technical Proficiency Collaborate with business stakeholders to gather and define user requirements and translate them into user stories and acceptance criteria. Prioritize and maintain the product backlog, ensuring that all items are clearly described, estimated, and prioritized. Maintain comprehensive documentation of requirements, solutions, and changes for reference. Guide the development team by providing necessary clarification and details on business requirements and functionality. Facilitate communication between development teams and non-technical stakeholders to ensure alignment and understanding. Provide technical insights on challenges and propose solutions that align with the business needs

We are looking for a highly skilled and tech-savvy customer support specialist who can provide exceptional support to our U.S.-based healthcare clients. The ideal candidate must have strong knowledge of electronic medical records (EMRs), U.S. healthcare policies, and regulations, along with outstanding problem-solving skills in IT and technology-related issues. A clear American English accent is required to ensure seamless communication with customers. Key Responsibilities: Provide level 1 and level 2 technical and customer support for healthcare clients using our AI and blockchain solutions. Troubleshoot and resolve issues related to EMR/EHR systems, medical billing software, and other healthcare technologies. Assist clients with IT-related challenges, including software integrations, cloud-based solutions, and data security concerns. Educate customers on healthcare compliance requirements, such as HIPAA, Medicare, Medicaid, and telehealth policies. Work closely with internal teams (IT, product development, and sales) to escalate and resolve complex technical issues. Maintain accurate records of customer interactions and issue resolutions in a CRM system. Ensure high customer satisfaction by providing clear, concise, and professional communication. Required Qualifications: 3+ years of experience in customer support for healthcare IT solutions or electronic medical records (EMR) systems. Strong understanding of U.S. healthcare regulations, HIPAA compliance, and medical billing practices. Excellent troubleshooting skills in IT, software applications, and system integrations. Fluent in English with a clear American accent (must be comfortable speaking with U.S. clients). Experience using CRM software, ticketing systems, and remote support tools. Strong interpersonal skills and the ability to explain technical concepts to non-technical users

Qualification:- Doctor of Medicine, Physician, Doctor of Medicine, MBBS/BAMS/BHMS/BDS Desired healthcare certifications: 1. CPC or COC (AAPC) 2.0CCS (AHIMA) Required / Essential skills. Experience in Claims adjudication process end-to-end Ability to learn and become proficient using an integrated payment integrity technology platform 2 years experience in claims that demonstrates knowledge in HIPAA guidelines, ICD-10 coding, CPT/HCPCS/HIPPS coding Experience in the health care industry (Medicare, Medicaid, and/or Commercial) Advanced proficiency in MS word, Excel, and PowerPoint Proficiency in written and verbal communication Effectively coordinate with the internal team and stake holders Ability to work independently and as a team Keep up to date on industry trends and opportunities to apply best practices to payment integrity and claims processing Ability to think analytically, apply analytical techniques and to provide in-depth analysis and recommendations to senior management using critical thinking and sound judgement Must be a team player and adaptable to a dynamic work environment Proven interpersonal skills Strong written and verbal communication skills Good analytical, decision making and problem-solving skills Strong clinical knowledge and effective use of multiple applications, systems, and resources.

Interested Candidates may connect with Ms.Aditi Anand-+91 78170-00490 (11am-5pm) About the Role: We are seeking a highly motivated and experienced individual with a medical background to join our dynamic team as a Medical Claims Call Center Representative. In this role, you will be the frontline of our customer service, handling inbound calls related to medical claims and rejections. Your primary focus will be to provide exceptional customer service while resolving inquiries and concerns effectively, ensuring a positive experience for every Niva Bupa member. Key Responsibilities: Answer incoming customer calls promptly and professionally. Assist customers with navigating medical claims, including inquiries about submissions, rejections, and procedures. Provide accurate and detailed information about claim processes, documentation requirements, and insurance coverage. Investigate and resolve customer concerns with a focus on high satisfaction and clear communication. Collaborate with internal departments like claims processing to address complex issues and expedite resolutions. Maintain extensive knowledge of Niva Bupa products, medical billing codes, and claim procedures. Document customer interactions and update records accurately in our system. Identify and escalate critical or unresolved issues to the appropriate supervisor. Adhere to company policies, procedures, and compliance guidelines. Key Requirements: Education & Certificates: Any Life science, Paramedical, Medical Graduate or Post-Graduate (Pharmacy, Physiotherapy) or equivalent degree. Minimum 1-3 years of call center experience, preferably in healthcare or medical insurance. Strong knowledge of medical terminology, insurance claim procedures, and billing codes. Excellent verbal and written communication skills. Ability to handle high call volumes and prioritize customer needs effectively. Strong problem-solving and decision-making abilities. Attention to detail and accuracy in data entry and documentation. Exceptional customer service skills with a friendly and professional demeanor. Proficiency in computer systems, including CRM software and Microsoft Office Suite. Ability to work effectively in a team-oriented environment. Flexibility to work various shifts as per business requirements. What you'll gain? A competitive salary package of up to Rs. 3.5 LPA, based on your experience and Interview performance. Be part of a growing and respected healthcare company. Make a real difference in the lives of our members by providing exceptional customer service. Work in a dynamic and supportive environment with opportunities for growth and development. Competitive salary and benefits package. Ready to join Niva Bupa and contribute to a team dedicated to improving lives? Apply today!

JD- Retrieve medical records from healthcare facilities, ensuring accuracy and completeness of records. Ensure compliance with HIPAA and other regulatory standards regarding the privacy and security of medical records. Process release of information requests for authorized parties such as patients, legal entities, insurance companies, and other healthcare providers. Organize and maintain medical records in both paper and electronic formats, ensuring they are accessible and easily retrievable. Coordinate with other departments (e.g., billing, insurance) to provide requested information while safeguarding patient confidentiality. Review and verify records for completeness and accuracy before releasing them. Perform audits of medical records to ensure accuracy and compliance with regulatory standards. Skills & Qualifications: Experience in healthcare administration or medical records management (preferred). Knowledge of HIPAA regulations and patient confidentiality. Strong communication skills (for calling positions). Excellent attention to detail and organizational skills. Ability to work efficiently and accurately in a fast-paced environment. Experience with medical records systems and software (e.g., Epic, Cerner, etc.) preferred. Ability to handle sensitive information with professionalism and discretion. Salary & Benefits: Competitive salary based on experience. Health and Accidental insurance. Contact number- 9650506346

Role & responsibilities : Enrolls providers (individually or in groups) with Medicare, Medicaid, and all major private insurance payers. Verifies completeness and accuracy of application documents, coordinates with onshore team and payer support to obtain all necessary information. Promptly submits applications to ensure maximum reimbursement for all providers. Performs electronic funds transfer (EFT) and electronic remittance advice (ERA) enrollment for all providers, for all applicable payers. Compiles and maintains a list of provider participation (by payer). Identifies missing, incorrect, or expired credentials. Performs ongoing follow up with onshore team and payer support to ensure provider credentials remain correct and valid. Revalidates provider enrollment, based on frequency required by individual payers. Ensures team delivers quality service, in accordance with each clients Service Level Agreement (SLA) Encourages smooth daily operations, and maintains daily operations reports, as necessary. Monitors team productivity and provides guidance and motivation Delivers feedback on processes, workflows, and team productivity to Manager. Leads by example. Fulfills all compliance responsibilities related to the position, handles all protected health information in a manner consistent with Health Insurance Portability and Accountability Act (HIPAA) regulations Must be available for special projects Willing to work in Night shift ( Only Male candidates are eligible for this position ) If interested kindly share CV to 7358703376/nabdhulrahuman@health.saisystems.com Contact Person: Nainar Mohamed Contact Number: 7358703376

Job Title: Configuration Analyst Location: India Grade: F2 Department: BPaaS Reports To: BPaaS Configuration Director/ Configuration Lead 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. Configuration Analyst Location: Any Location (WFH) Shift Time - Night Shift Duties and Responsibilities: Configuration of Healthcare Payer (Health Plan) Core Administrative Platforms: Design and Configure the benefits, system parameters, and pricing requirements on the Health Plan (Payer) core administrative platforms for various lines of business, including Medicare, Medicaid, Commercial, and Individual-Exchange, ensuring compliance with business requirements and regulatory standards. Requirements Gathering and Analysis: Collaborate with clients and internal stakeholders to gather and document configuration requirements, ensuring a clear understanding of client needs and project objectives. Configuration Design and Execution: Develop detailed configuration designs, incorporating feedback from clients and internal stakeholders, and obtain approval prior to implementation. Execute configuration activities as per the approved design, ensuring accuracy and alignment with client specifications. Testing and Quality Assurance: Partner with the testing team to conduct thorough testing of configurations, review results, and make necessary adjustments to ensure quality and performance standards are met. Minimum Required Skills and Qualifications: Minimum of 2+ 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 Strong communication skills, with demonstrated ability to engage effectively with clients and internal stakeholders.

As a Program Specialist, you'll play a vital role in ensuring accurate patient information for the insurance reverification. You'll be responsible for: Outbound Calling: Conducting calls to payers to verify medication details, costs, and eligibility for coverage. Benefits Investigation: Working closely with doctor's offices to investigate insurance benefits and coordinate prior authorizations. Patient Assistance: Providing comprehensive support to patients, including identifying alternative coverage options and tracking prescription orders. Key Responsibilities Document calls and efficiently handle escalations. Conduct insurance verifications and coordinate prior authorizations. Process patient applications and follow up on inquiries. Liaise with distributors and manufacturers for product requests. Coordinate prescription transfers to specialty pharmacies. Educate patients on available insurance options. Assist with training new team members. Maintain a professional and friendly Demeanor. Qualifications: Graduation- Bachelors degree 1-year minimum Customer service, healthcare preferred Insurance benefits verification experience Previous International Call center experience (Outbound) Experience with benefits investigation, Experience working remotely in US shift (6pm- 3am) Computer/technology experience Strong communication skills

We are seeking a dynamic and experienced Training Manager to oversee the training needs of a team comprising up to 500-600 employees. • The ideal candidate will have strong leadership skills to manage a team of training trainers and drive the effective execution of training programs. • They will be accountable for various aspects of training, including new hire training, performance monitoring during the initial period, and continuous knowledge management during regular operations. • People Management: Lead and mentor a team of training trainers to ensure they meet their objectives and deliverables effectively Training • Program Development: Collaborate with stakeholders to design comprehensive process training plans tailored to the organization's needs. Assess and enhance the effectiveness of training materials, including Standard Operating Procedures (SOPs), Participant and Facilitator Guides, and Learning Check Points. • Execution and Oversight: Execute training deliverables under the guidance of the Training Manager, ensuring alignment with organizational goals and standards. Conduct audits, Performance Knowledge Transfer (PKT) calibrations with Quality Assurance (QA), and Training Needs Assessments (TNA) for employees in day-to-day operations. • Monitoring and Improvement: Track and provide detailed updates on the progress of training batches, identifying areas for improvement and optimization. Conduct periodic follow-ups on below quality (BQ) employees, providing tailored training and refreshers to enhance performance. • Certification and Development Programs: Organize certification programs and other developmental workshops for auxiliary trainers to enhance their skills and capabilities.• Process Improvement: Regularly review and revise standard operating procedures (SOPs) in consultation with clients, ensuring alignment with best practices and evolving business needs. • Compliance and Reporting: Ensure adherence to training governance mechanisms outlined in the Training Standard Document (TSD).Prepare, publish, and maintain various training reports and dashboards to track key performance indicators and inform decision-making. Qualifications Graduate is a must

Job Title : AR Caller & US Healthcare Medical Billing RCM Specialist Job Description : We are seeking a skilled AR Caller & US Healthcare Medical Billing RCM Specialist to manage and optimize revenue cycle processes for our healthcare clients. The ideal candidate will handle accounts receivables, follow up on denied or unpaid claims, and work directly with insurance companies to resolve outstanding issues. The role requires a deep understanding of medical billing, claims processing, and insurance follow-up within the US healthcare system. Key Responsibilities : Manage accounts receivable, including timely follow-up on unpaid claims Call insurance companies to resolve denied or delayed claims Investigate and address claim rejections or underpayments Review and submit appeals for denied claims Maintain accurate documentation and reporting on claim statuses Collaborate with billing teams to improve revenue cycle processes Stay updated on payer rules, regulations, and changes in billing practices Qualifications : 1+ years of experience in US healthcare billing and RCM processes Familiarity with EOBs, denials, and insurance payer policies Excellent communication and negotiation skills Proficiency in medical billing software and MS Office Hiring for freshers salary 10.7k to 17k ( Depends on last drawn salary) Location- Mumbai Preferred : Certification in Medical Billing and Coding or equivalent Experience with Medicare/Medicaid billing Location : Pune / Navi Mumbai / Banglore / Andheri / Ghansoli Job Type : Full-time Contact Details. Shreya - 9136512502

Skill required: Operations Support - Pharmacy Benefits Management (PBM) Designation: Health Operations Associate Qualifications: Bachelor of Pharmacy Years of Experience: 1 to 3 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.In Pharmacy Benefits Management, you will be responsible for 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 Prioritization of workload Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your expected interactions are within your own team and direct supervisor You will be provided detailed to moderate level of instruction on daily work tasks and detailed instruction on new assignments The decisions that you make would impact your own work You will be an individual contributor as a part of a team, with a predetermined, focused scope of work Please note that this role may require you to work in rotational shifts Qualifications Bachelor of Pharmacy

Dear All, Greetings from Flatworld Healthcare Services. WE ARE HIRING !! Job Title: CPC Certified Medical Coder in Multi-Specialty (Primary Care, Dental & Chiropractic) Location: Bangalore Shift: Night Shift Experience: 1 - 3 Years Notice Period: Immediate Joiners Preferred Employment Type: Full-Time, Permanent Interested candidates can share their CVs at pavan.v@finnastra.com or contact 9035473861 (Available between 11 AM - 9 PM ). Job Description: We are seeking a CPC-certified Medical Coder with a minimum of 2 years of experience in multi-specialty coding, specifically in Primary Care, Dental, and Chiropractic services within Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC) settings. The ideal candidate should have strong expertise in CPT, ICD-10, HCPCS coding, and compliance with CMS and payer-specific guidelines. Key Responsibilities: Accurate Coding: Assign and review CPT, ICD-10, and HCPCS codes for Primary Care, Dental, and Chiropractic services, ensuring compliance with RHC/FQHC billing regulations. Claims & Compliance: Ensure claims meet payer policies, Medicare/Medicaid regulations, and RHC/FQHC-specific coding guidelines. Audit & Quality Assurance: Conduct internal coding audits, identify discrepancies, and implement corrective actions to improve accuracy. Denial Management: Work with the billing team to review and resolve coding-related denials and rejections. Documentation Review: Collaborate with providers to ensure appropriate documentation supports coding and reimbursement. Coding Education: Provide feedback and training to providers and staff on documentation improvement and coding updates. Stay Updated: Keep abreast of CMS, Medicaid, and commercial payer guidelines , ensuring compliance with evolving industry standards. Qualifications & Skills: Certification: Certified Professional Coder (CPC) from AAPC (Required). Experience: Minimum 2 years of multi-specialty coding experience in Primary Care, Dental, and Chiropractic services. Preferred Experience: Working knowledge of RHC/FQHC billing and coding guidelines. Software Proficiency: Experience with EHR/EMR systems and coding tools . Regulatory Knowledge: Understanding of Medicare/Medicaid billing , HIPAA, and compliance regulations. Analytical & Communication Skills: Strong attention to detail and ability to communicate effectively with providers and billing teams. Preferred Qualifications: Experience with Medicaid and Medicare Advantage plans . Additional certifications such as CRC, COC, or CPMA are a plus. Prior experience in denial management and revenue cycle optimization . Benefits: Competitive salary & performance incentives. Health benefits & professional development opportunities. Flexible work environment ( Remote/Hybrid as per company policy ).

Candidate should have 3+ years of experience in EDI transaction processing, mapping, and troubleshooting for US healthcare payor environment. Shift - Rotational Shifts Work Location - Chennai Required Candidate profile Immediate Joiners OR Max 1 month notice period candidates can apply Call HR Manager Reejo @ 9886360719 for more details.

Minimum 1-3 years of experience working in credentialing. Candidate must have knowledge in END to END provider credentialing Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid. Required Candidate profile Candidate must have knowledge in creating & attesting the CAQH profiles Group Medicare and Medicaid Enrollment/Contracts. Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.

Medical Coding Associate Job Description: Qualification Requirements Current Coding Certification (CPC, CPC-P, CPC-H, CPC-I, CRC, CCS, RHIT, RHIA etc.) through AAPC and/or AHIMA Minimum of 2+ years coding experience with specific knowledge of Medicare and Commercial Risk Adjustment such as Hierarchical Condition category (HCC). Additional experience in facility (OPPS/IPPS) coding experience is preferred Additional experience in Health Plan Risk Adjustment Data Validation Audit (RADV) experience is preferred Experience and Skills Ability to work independently in a fast-paced remote environment with minimal supervision and guidance Ability to interact with management personnel Possess strong organizational skills and attention to detail Ability to adapt to changing priorities while managing a wide range of projects Adaptive and flexible to new ideas and change Advanced knowledge of medical terminology, anatomy, and pharmacology Advanced skills utilizing official coding resources for research and problem solving Advanced skills and knowledge of computers, use of required software to perform job functions Excellent written and communication skills and the ability to explain complex information Demonstrate strong analytical skills, organizational skills, attention to detail, excellent verbal and written communication skills Good understanding of audits strategies and framework Knowledge of basic Quality tools Knowledge on Audit Sampling frameworks and analysis Performance Analysis Interpret and implement Quality Assurance Standards and procedures Role & responsibilities Shift timings - Rotational shift Thanks & Regards Lalitha 9281037167 sri.lalitha@spsoftglobal.com

The Customer service role : - Respond to customer inquiries via chat/email - Provide health benefits info/support - Communicate effectively online - Use technology tools - Provide product info/engage customers - Adapt to changing programs/policies Required Candidate profile Female candidate only can apply Technical: Computer proficiency, helpdesk/CRM software Experience: 0-18 months, 6+ months Medicare Advantage (MA) exp Keyboard skills (30-35 words per minute)

Please note - This Profile is not into Finance Sector. Job Title : AR Caller / Credentialing Specialist Location : Pune, Navi - Mumbai and Nagpur (Work from Office) Company Profile : First Insight is a software product development and revenue cycle management company based in Portland, Oregon (USA). It has its India development and service delivery centre in Pune, Mumbai and Nagpur. Its expertise and domain lies in healthcare and insurance. Its a forward thinking, visionary company that provides high quality software solutions, services, support and training to nearly a thousand optometric and ophthalmic practices in the United States .It has carved a niche in the healthcare industry with its practice management and electronic health records software, support, e-commerce solutions and revenue cycle management services. To know more about First Insight, please visit @ www.first-insight.com . We are hiring AR Callers for our facility in Pune, Mumbai and Nagpur. The AR callers have to work from office upon joining. The details are as under: Job Description: • Reduce AR aging of clients and increase their cash flow. Ensure that AR aging always meets industry standards. • Review and analyze unpaid or denied insurance claims. Contact insurance companies to follow up on outstanding claims, determine the reason for non-payment, and resolve any issues leading to delays or denials. • Constantly keep track of both electronic and paper claims. • Identify claims that have been denied and prepare necessary documentation for appeals. Resubmit corrected claims with accurate information and supporting documents as required by the insurance company. • Investigate and resolve discrepancies in billing records, such as incorrect coding, missing information, or duplicate charges. Coordinate with internal departments to ensure accurate billing practices. • Maintain detailed and organized records of all communication, interactions, and follow-up actions taken with insurance companies, and other relevant parties. • Analyze reasons for claim denials and work with billing and coding teams to address underlying issues. Implement strategies to minimize future claim denials. • Verify patient insurance coverage and eligibility, ensuring accurate and up-to-date information is available for claims submission. In case the patient does not have sufficient insurance coverage for the medical procedure or if the patient is in any way not eligible for coverage, transferring the outstanding balance to the patient. Monitor aging reports to identify and prioritize accounts that require immediate attention. Take proactive measures to expedite payment collection on aging accounts. • Collaborate with colleagues in billing, coding, and revenue cycle departments to ensure seamless communication and resolution of payment related issues. • Adhere to HIPAA regulations and industry standards to maintain patient confidentiality and ensure compliant billing practices. Qualifying Criteria: • Strong knowledge of medical billing and insurance procedures, including CPT and ICD-10 codes. • At least 1+ year of experience in AR Calling in an Accounts Receivable process in US Healthcare (End to End RCM Process) • Ability to multi-task • Good organization skills demonstrating the ability to execute timely follow-ups • Willingness to be a team player and show initiative where needed • Ready to work in night shifts • Excellent oral and written communication skills Salary: Remuneration will be at par with the best industry standards; will not be a constraint for the right candidate. Kindly Note - RCM (Revenue cycle management) Knowledge is mandatory. Interested Candidate can directly call / Share there resume with H.R - Shubham More - 8369218615

US Health Care Domain Knowledge. E.g. Encounters, EDI, HIPAA, 837 Layout, insights into Medicare and Medicaid, Markets etc. Facets/QNXT 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 Shift & Mode of work: US Shift & WFO Interested, kindly share your updated resume to the below email Deepika: deepika.r246382@cognizant.com

The Female candidate needs to review outstanding insurance balances, resolve issues, coordinate with payers/patients/clients. Analyze data, identify trends, recommend solutions. Manage accounts receivable, ensure timely completion of workflow items. Required Candidate profile MS Office (Excel, Outlook), typing skills. 12+ months healthcare AR experience, denial management. Knowledge of medical insurance (HMO, PPO, Medicare, etc.).

Minimum of 3 years of experience in technical writing, with a focus on business operations policies and procedures for US Healthcare Qualification - Graduate Work Location - Chennai Shift - Rotational shifts Required Candidate profile Immediate Joiners OR Max 1 month notice period candidates can apply Call HR Manager Reejo @ 9886360719 for more details.

Job description Team Executive - Claims Adjudication Location : Hyderabad Roles & Responsibilities: In-depth Knowledge and Experience in the US Health Care Payer System. 4 - 6 years of experience in Claims Adjudication . With over 1 year of experience as a Team leader Proven track record in managing processes, streamlining workflows and excellent people management skills. Need to be a people centric manager who could articulate the employee challenges to the management as well as motivate the team towards desired project goals. Circulate quality dashboards at agreed periodic intervals to all relevant stake holders Adhering to various regulatory and compliance practices. Maintaining and Ownership of reports both internal as well as for the clients. Presenting the data and provide deep insights about the process to the clients as well as Internal Management. Managing and co- ordinating training programs. Excellent in Coaching and providing feedback to the team. Take necessary HR actions as part of the Performance Improvement Process Key Performance Indicators Ensuring that the key Service Level Agreements are met consistently without any exceptions. Leverage all Operational metrices to ensure that the Revenue and Profitability targets are met and exceeded . Work in tandem with all Business functions to ensure smooth business process. Retention of key team members Interested Candidates share your CV - deepalakshmi.rrr@firstsource.com / 8637451071

The SNF Revenue Cycle Manager oversees all billing, coding, A/R, and collections to ensure proper reimbursement for skilled nursing facility services. Key Responsibilities: Manage SNF-specific revenue cycle workflows . Oversee PDPM billing accuracy and Medicaid reimbursements . Work with state Medicaid agencies to resolve claim issues . Analyze aging reports and improve collections performance . Ensure compliance with CMS and state Medicaid billing requirements. Deep knowledge of PDPM, RUG-IV, and Medicaid case-mix reimbursement models .

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 bodiesTechnical 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 IndividualEducational 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