3.0 - 7.0 years

0 Lacs

karnataka

On-site

As a Medical Claims Review Senior Analyst/Clinical Supervisor in the Complex Claim Unit, you will provide clinical review expertise for high dollar and complex claims, including facility and professional bills. Your role includes identifying coding and billing errors, ensuring the application of Medical and Reimbursement Policies for cost containment, and identifying cases for potential fraud and abuse. Your major responsibilities will involve evaluating medical information against criteria, benefit plans, and coverage policies to determine the necessity for procedures. In cases where criteria are not met, you will refer to the Medical Director. You will also evaluate itemized bills against ...

Posted 1 month ago

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Sr. Process Associate- Behavioral Healthcare Billing Med Karma

3.0 - 7.0 years

0 Lacs

noida, uttar pradesh

On-site

As a Sr. Process Associate- Behavioral Healthcare Billing at Med Karma, you will be responsible for handling medical billing solutions for healthcare providers specializing in behavioral health. With a minimum of 3 years of experience in this field, you will demonstrate expertise in behavioral health billing, coding, and reimbursement policies. Your role will involve managing a wide range of billing functions, including utilization management, prior authorization, claims review, and analyzing denials to develop effective appeal strategies. You should possess good communication skills and a strong understanding of revenue codes related to IOP/PHP services. Additionally, you must navigate carv...

Posted 1 month ago

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Accounts Receivable - AGM / DGM - US Healthcare PrimEra Medical Technologies

12.0 - 16.0 years

0 Lacs

hyderabad, telangana

On-site

The role of overseeing the hospital's accounts receivable operations is crucial for ensuring efficient billing, collections, and follow-up on outstanding balances. As the Accounts Receivable Manager, you will be responsible for managing a team of billing specialists and other staff, overseeing their performance in accounts receivable functions. Your key duties will include developing and implementing processes to enhance billing and collections efficiency, analyzing accounts receivable reports and key performance indicators to identify trends and areas for improvement, and ensuring compliance with current US healthcare regulations and reimbursement policies. In this leadership role, you will...

Posted 3 months ago

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Nurse Reviewer | Medical Coding, Billing, Claim, Clinical Expertise | V3 Staffing

3.0 - 8.0 years

10 - 12 Lacs

Hyderabad

Work from Office

Our reputed MNC Client is hiring for Nurse Reviewer role: Shift: 11:30 AM - 8:30 PM Work Mode: Work From Office (5 days) Location: Hyderabad Job Summary: We are seeking an experienced Nurse Reviewer to conduct in-depth claim reviews based on medical guidelines, clinical criteria, and billing rules. The ideal candidate will have a strong understanding of medical coding, clinical experience, and excellent communication skills. Key Responsibilities: - Conduct claim reviews to identify areas with savings potential - Review and validate charges against medical documentation - Contact medical providers to resolve billing inconsistencies - Manage claims reports and prioritize according to client st...

Posted 4 months ago

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