10 Payment Integrity Jobs

Location: Jayanagar, Bangalore (Work from Office) Experience Required: Analyst: 3+ years (Budget upto 10 LPA) Team Lead: 5+ years (Budget upto 13 LPA) Manager: 10+ years (Budget up to 20 LPA) Sr. Manager: 13+ years (Budget up to 30 LPA) Key Responsibilities: Manage 13 end-to-end medical reimbursement payment policies (based on role level) Identify and implement rules to detect incorrect healthcare payments Analyze Medicare/Medicaid edits, coding guidelines, and reimbursement frameworks Translate clinical coding guidelines and industry references into actionable business logic Ensure coding compliance and maintain alignment with CMS and payer policies Collaborate across teams and operate independently Requirements: Strong expertise in Payment Integrity, Denials Logic & Management Deep knowledge of CPT, ICD, LCD/NCD, PTP, NCCI, modifiers, and billing guidelines Experience with claim forms (UB-04, CMS 1450, CMS 1500) Proficient in data analysis and deriving insights from CMS/Medicaid policies High attention to detail, adaptability, and strong communication skills Educational Qualification (any one): MBBS, BDS, BPT, BAMS, B.Sc. Nursing, PharmD, B.Pharm, M.Pharm Life Sciences (Microbiology, Biochemistry, etc.) Other relevant degrees with domain experience Certifications (Mandatory): Any of the following: CPC, CPMA, COC, CIC, CPC-P, CCS (AAPC or AHIMA) Additional AAPC specialty certifications and Lean Six Sigma preferred Key Skills: Medical Coding, Payment Integrity, RCM, CPT/HCPCS, ICD, DRG, Medicare/Medicaid policies, Data Analysis, MS Excel & Word, Communication Benefits: Competitive compensation Family health insurance & personal accident coverage Flexible leave policy Certification/course reimbursements Medical Coding CEUs and membership renewals Annual health checkups

Job description Team Executive - Payment Integrity Location : Bangalore Roles & Responsibilities: In-depth Knowledge and Experience in the US Health Care Payer System. 4 - 9 years of experience in Claims Adjudication(Payment Integrity,PrePay audit,Postpay audit) . 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 Disclaimer: Firstsource follows a fair, transparent, and merit-based hiring process. We never ask for money at any stage. Beware of fraudulent offers and always verify through our official channels or deepalakshmi.rrr@firstsource.com

Openings for SME/TL/Quality/Trainer roles Need candidates with exp in US health care claims adjudication -payment integrity process 5 days working/rotational shifts Chennai/Bangalore location Interested Candidates do call Sadiq @ 8904378561 Required Candidate profile Openings for SME/TL/Quality/Trainer roles Need candidates with exp in US health care claims adjudication -payment integrity process Interested Candidates do call Sadiq @ 8904378561

The candidate should be working as a Quality Analyst / Trainer in the US healthcare industry for the Claims Adjudication Payment Integrity process. Qualification - Graduate Shift - US rotational shifts Work Location - Chennai and Bangalore Required Candidate profile Immediate Joiners OR Max 1 month notice period candidates can apply Contact Sr. HR Kenedy at 9620999035 for more details.

The candidate should be working as a Team Leader/SME in the US healthcare industry for the Claims Adjudication Payment Integrity process. Qualification - Graduate Shift - US rotational shifts Work Location - Chennai and Bangalore Required Candidate profile Immediate Joiners OR Max 1 month notice period candidates can apply Contact Sr. HR Kenedy at 9620999035 for more details.

Job description Preferred candidate profile : Bachelors degree Proven experience in training with over 1+ years of experience as a Trainer on papers. Minimum of 3 years of experience from Healthcare Payer side ( Claims & Payment Integrity ) Experience with the development of training materials including presentations, user manuals, and assessments. Classroom management skills Strong analytical and technical skills Exceptional organizational abilities Excellent interpersonal and communication skills. Visionary mindset with the ability to identify and implement innovative training solutions. Ability to thrive in a fast-paced and dynamic work environment. Familiarity with learning management systems and digital training platforms (ex: Articulate 360 applications) is a plus Roles & Responsibilities: Conducting multiple trainings for new hires and managed nesting along with certification process Maintain the training effectiveness above the required threshold by holding strong governance process in training Ability to read through various standard operating procedures and communicate the extracts to the trainees clearly Identify gaps between internal process and customers expectations to help business produce the desired outcome Create content / training material for effective training Revamp the training materials to suit the need of current business and easy understanding / knowledge transfer to trainees Liaison with QA to calibrate process knowledge Conduct workshops for project team members on recent update and US healthcare industry trends Perform user acceptance testing for any new process rollouts / automation in the program Provides refresher training for bottom quartile Support the team by performing floor trouble shooting to ensure all relevant queries are tracked and answered appropriately Periodic knowledge calibration with client Interested candidates kindly share your updated CV to gsyed.suhail@firstsource.com Contact: Suhail HR - 9290528486 (WhatsApp) Disclaimer: Firstsource follows a fair, transparent, and merit-based hiring process. We never ask for money at any stage. Beware of fraudulent offers and always verify through our official channels or @firstsource.com email addresses.

Job description Team Executive - Payment Integrity Location : Chennai & Bangalore Roles & Responsibilities: In-depth Knowledge and Experience in the US Health Care Payer System. 4 - 9 years of experience in Claims Adjudication(Payment Integrity,PrePay audit,Postpay audit) . 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 Disclaimer: Firstsource follows a fair, transparent, and merit-based hiring process. We never ask for money at any stage. Beware of fraudulent offers and always verify through our official channels or deepalakshmi.rrr@firstsource.com

1. Product Strategy & Roadmap Development: Develop and execute a strategic product roadmap for payments integration that aligns with the banks overall digital banking strategy and business objectives. Drive innovation in corporate payment solutions , focusing on integrating payment platforms and fintech solutions to provide a superior and competitive offering to clients. Create clear, data-driven product requirements based on market research, customer feedback, and internal stakeholder input. 2. Payment System Integration & Architecture: Lead the integration of various payment systems (e.g., RTGS, NEFT, IMPS, UPI, card payments, SWIFT) into the bank's digital channels (web, mobile, and API-based platforms). Collaborate with engineering and tech teams to define API specifications for payments, ensuring smooth integration between external payment platforms and internal banking systems. Ensure that payment infrastructure is scalable, secure, and capable of handling high volumes of transactions with minimal latency. Oversee the integration of payment processing solutions with third-party providers , including fintechs and external payment networks. 3. Cross-Functional Collaboration: Collaborate with engineering, IT, legal, compliance, and risk teams to ensure that all payment integrations adhere to regulatory guidelines and security standards (e.g., PCI-DSS compliance, data encryption). Work with business development and relationship management teams to understand client needs, ensuring that payment integration solutions address the unique requirements of corporate clients. Engage with vendors, third-party service providers, and fintech partners to build and enhance the payment integration ecosystem. 4. Technology Leadership & Engineering Collaboration: Leverage your engineering background to understand complex technical challenges in payments integration and provide technical guidance to the team. Work closely with engineering and IT teams to ensure successful product delivery, providing oversight on API design, integration, performance testing, and troubleshooting. Ensure that payment platforms are developed and deployed using the latest technologies such as microservices architecture , cloud infrastructure , and containerization . Continuously improve integration processes, enhance automation, and apply best engineering practices to optimize performance and security. 5. Innovation & Digital Transformation: Stay at the forefront of emerging payment technologies , including blockchain , tokenization , digital wallets , real-time payments , and cross-border payments , and explore opportunities for their adoption within the bank. Evaluate new fintech innovations and trends, ensuring that the bank’s payment products are competitive, innovative, and future-proof. Explore AI and machine learning opportunities for fraud detection, payment authentication, and predictive analytics in payments processing. 6. Client Experience & Product Usability: Ensure seamless customer experience by developing intuitive, user-friendly interfaces and optimizing transaction flows across digital platforms. Work with the UX/UI design team to ensure the corporate payment platform provides an optimal, secure, and efficient user experience. Gather customer feedback and collaborate with customer support teams to address issues, streamline processes, and enhance product offerings. 7. Performance Monitoring & Reporting: Define, monitor, and report on key product performance metrics, including uptime, transaction speed, customer adoption, and user satisfaction. Use analytics to track product performance and continuously iterate on product features to meet evolving customer and business needs. Provide regular updates to senior management and stakeholders regarding product milestones, technical challenges, and improvements. 8. Compliance, Security, and Risk Management: Ensure that the payment integration solutions comply with local and international regulatory requirements, such as KYC , AML , data privacy laws , and PSD2 . Ensure the integration and operation of payments systems are secure, protecting against fraud, cyberattacks, and unauthorized access. Collaborate with the risk and compliance teams to build systems that are resilient to potential threats and vulnerabilities. Required Skills and Qualifications: Education : Bachelor’s or Master’s degree in Computer Science , Engineering , or related technical fields. MBA or Post-graduate qualification in Business/Finance is a plus. Experience : 2-3 years of experience in product management with a focus on payments integration or payment systems in the banking or fintech industry. Strong understanding of payment technologies such as RTGS, NEFT, IMPS, UPI , SWIFT , payment gateways , and payment processors . Proven experience in API design , systems integration , and working with cloud-based payment solutions . Demonstrated success in working with corporate clients , understanding their payment needs, and delivering effective, scalable solutions. Solid experience in working closely with engineering teams to deliver technical solutions, particularly those involving microservices , RESTful APIs , and cloud infrastructure . Skills : Expertise in payment system architecture and integration strategies . Strong technical background with a deep understanding of backend systems and payment infrastructure. Knowledge of API design , integration frameworks , and payment industry standards . Experience with Agile product management methodologies and cross-functional project management. Strong leadership, communication, and problem-solving skills. Ability to navigate complex technical challenges and find innovative solutions. Technology Skills : Familiarity with cloud technologies (AWS, Azure, GCP) and payment API platforms . Knowledge of microservices architecture , containerization , and DevOps practices in payment systems. Proficiency with payment processing systems and transaction flow management. Understanding of security standards (e.g., PCI-DSS , OAuth , Tokenization ) and fraud detection technologies .

Candidate should have experience working as a SME for US Healthcare in Claims adjudication process. Shift - Rotational shifts Work Location - Chennai Immediate Joiners OR Max 15 days notice period candidates can apply Required Candidate profile Call HR Swapna @ 7411718707 for more details

Candidate should be working as a SME OR Quality analyst in US Healthcare for Payment integrity process. Qualification - Graduate Shift - US rotational shifts Work Location - Chennai Required Candidate profile Immediate Joiners OR Max 1 month notice period candidates can apply Call HR Swapna @ 7411718707 for more details.