7 Reimbursement Processes Jobs

About RISA Labs Cancer patients face not just a disease, but a broken system where delays in treatment are common due to outdated, error-prone workflows. RISA Labs is changing that with our Business Operating System as a Service (BOSS) - a powerful platform built for the vertical complexity of healthcare, that transforms healthcare operations. Unlike simple automation tools, BOSS breaks down complex workflows into small tasks, managed by smart AI agents like LLMs, digital twins, and reinforcement learners. This creates a digital workforce that doubles the efficiency of healthcare teams, letting a 1,000-person institution operate like it has 2,000 staff overnight. Founders RISA was founded by Kshitij Jaggi and Kumar Shivang, IIT Kanpur alumni with a proven track record from their previous healthcare startup, Urban Health. Their vision is to streamline oncology care through cutting-edge technology. Funding RISA Labs is backed by $3.5 million in seed funding, led by Flipkart co-founder Binny Bansal, with support from Oncology Ventures, General Catalyst, z21 Ventures, Odd Bird VC, and angel investor Ashish Gupta. Role Overview We are seeking a detail-oriented Oncology Prior Authorization Specialist to manage and streamline the prior authorization (PA) process for oncology treatments and procedures. In this role, you will ensure timely and accurate approvals while maintaining compliance with insurance guidelines. You will collaborate with oncologists, nursing staff, billing teams, and insurance payers to facilitate access to necessary oncology care and remove barriers to treatment. Responsibilities Manage Prior Authorization Process: Oversee the entire prior authorization process for oncology treatments, procedures, and medications, ensuring timely and efficient approvals Review Requests: Evaluate prior authorization requests to confirm they meet medical necessity criteria and payer guidelines Collaborate with Care Teams: Work closely with oncologists, nursing staff, and billing teams to gather necessary clinical documentation and ensure it is submitted accurately and promptly Insurance Coordination: Coordinate with insurance companies to resolve coverage issues, denials, and appeals, ensuring that patients receive the care they need without unnecessary delays Record Keeping: Maintain accurate records of all prior authorization requests, including approvals, denials, and appeals, ensuring documentation is compliant and well-organized Proactive Problem Resolution: Identify and address barriers to timely approvals, proactively addressing payer-specific requirements and facilitating smoother workflows Policy & Guideline Updates: Stay informed on insurance policy changes, payer guidelines, and new oncology treatments to ensure compliance and accurate processing of requests Provide Feedback & Insights: Support oncology care teams by offering feedback to improve the prior authorization workflow and streamline operational efficiency Utilize Technology: Use electronic medical records (EMR) systems (e.g., OncoEMR) and prior authorization platforms to manage and streamline processes Compliance: Ensure all communications and documentation comply with HIPAA and other relevant regulatory standards Qualifications Experience: Minimum of 3 years of experience managing medical prior authorizations, specifically within oncology Preferred Experience: Experience working in a cancer center or with oncology clients is highly preferred Knowledge: In-depth understanding of oncology treatments, procedures, and insurance requirements for medical prior authorizations Insurance & Reimbursement: Strong understanding of insurance policies, reimbursement processes, and medical necessity criteria for oncology care Technical Proficiency: Proficient in EMR systems (e.g., OncoEMR or similar platforms) and multiple payer portals, plans, and prior authorization tools Communication Skills: Excellent communication and interpersonal skills, with the ability to effectively liaise between healthcare teams, patients, and insurance payers Detail-Oriented: Ability to maintain accurate and organized documentation in a fast-paced environment Collaboration & Independence: Ability to work independently and collaboratively with care teams in a dynamic oncology care setting Compliance Knowledge: Strong knowledge of HIPAA compliance and other regulatory standards Preferred Certifications: Certification in Medical Coding, Healthcare Administration, or a related field is a plus Show more Show less

You will be working as an EM Coder at Noida location for CorroHealth, a prominent provider of healthcare analytics and technology solutions across various healthcare entities. Your primary responsibility will be to meticulously review and accurately code medical records for outpatient services to facilitate the billing process and ensure proper reimbursement. Daily tasks will involve analyzing healthcare documentation, assigning appropriate codes for diagnoses and procedures, ensuring adherence to regulatory requirements, and collaborating with healthcare providers to clarify any information discrepancies. Keeping abreast of coding guidelines and industry updates will be crucial for this role. To excel in this position, you must possess a strong proficiency in medical coding and have a sound understanding of ICD-10, CPT, and HCPCS coding systems. A minimum of 1 year of EM coding experience specifically for outpatient services is required. Familiarity with healthcare documentation review, coding guidelines, regulatory compliance, and reimbursement processes is essential. Attention to detail and accuracy in coding, effective communication skills for engaging with healthcare providers, and the ability to work both independently and collaboratively are key attributes for success. Holding a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) credential would be advantageous. Previous experience in a similar role and knowledge of the healthcare industry are considered beneficial assets for this position.,

As a Claims Specialist at Quantanite, you will play a crucial role in reviewing, processing, and following up on insurance claims to ensure timely and accurate reimbursement. Your attention to detail and proactive approach will be essential in collaborating with internal teams, insurance companies, healthcare providers, and patients to resolve billing discrepancies and maintain compliance with all relevant regulations. Your key responsibilities will include reviewing claims for assigned offices, performing quality control checks on patient accounts, and analysing denial queues to identify outstanding claims. You will be responsible for following up on denied, underpaid, or rejected claims with insurance companies, investigating and resolving claim rejections or denials, and collaborating with the Insurance Verification team to confirm eligibility and coverage for patients. To excel in this role, you should have a solid understanding of claims management processes, exceptional organisational skills, and the ability to thrive in a fast-paced environment. Additionally, you should possess a high school diploma or equivalent education, with certification in medical billing or coding preferred. A minimum of 2 years of experience in claims processing, medical billing, or a related role is required. Proficiency in claims management systems and the Microsoft Office Suite is essential, along with a strong knowledge of insurance claim procedures, denial management, and reimbursement processes. Your strong analytical skills, attention to detail, excellent communication abilities, and the capacity to work independently or in a team environment will be key attributes for success in this role. At Quantanite, we offer comprehensive training, career growth opportunities, and a collaborative culture that values diversity, inclusion, and teamwork. Join us in making a global impact by partnering with leading brands to deliver exceptional results. Quantanite is an equal opportunity employer, committed to creating an inclusive environment for all employees.,

Job Title: Claims Specialist Location: Mumbai About Us Quantanite is a global outsourcing partner delivering exceptional customer experience and back-office solutions to some of the worlds leading brands. We take pride in our fast-paced, inclusive work culture that empowers individuals to perform at their bestwherever they are in the world. Position Overview We are seeking a detail-oriented and proactive Claims Specialist to join our team. This role is responsible for reviewing, processing, and following up on insurance claims to ensure timely and accurate reimbursement. You will collaborate closely with internal teams, insurance companies, healthcare providers, and patients to resolve billing discrepancies and maintain compliance with all relevant regulations. The ideal candidate will have a strong understanding of claims management processes, exceptional organisational skills, and the ability to work effectively in a fast-paced environment. Key Responsibilities Review claims for assigned offices and ensure timely submission. Perform quality control checks on patient accounts to verify accurate billing. Review and analyse denial queues to identify outstanding claims and unpaid balances. Follow up on denied, underpaid, or rejected claims with insurance companies to resolve billing discrepancies and secure correct reimbursement. Investigate and resolve claim rejections or denials, including preparing appeals or demands when necessary. Collaborate with the Insurance Verification team to confirm eligibility and coverage for patients, ensuring accurate billing information is recorded. Communicate with insurance companies, patients, and healthcare providers to obtain additional information needed for claim processing. Qualifications Education: High school diploma or equivalent required; certification in medical billing or coding preferred. Experience: Minimum of 2 years in claims processing, medical billing, or a related role. Technical: Proficiency in claims management systems and Microsoft Office Suite. Knowledge: Solid understanding of insurance claim procedures, denial management, and reimbursement processes. Attributes: Strong analytical skills, attention to detail, excellent communication abilities, and the ability to work independently or in a team environment. What We Offer Comprehensive Training: Tools, resources, and ongoing support to ensure your success. Career Growth: Opportunities for advancement within a growing international organisation. Collaborative Culture: A people-first environment that values diversity, inclusion, and teamwork. Global Impact: Be part of a company that partners with leading global brands to deliver exceptional results. Quantanite is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. Show more Show less

As an AR Caller with over 3 years of experience, you will be responsible for contacting insurance companies, patients, and healthcare providers to follow up on outstanding medical claims. Your main tasks will include identifying and resolving issues with unpaid or denied claims, reviewing and analyzing insurance remittance advice for accurate reimbursement, and maintaining up-to-date records of all communications and actions taken. Additionally, you will collaborate with internal departments to resolve billing discrepancies and coding issues, providing excellent customer service by effectively addressing inquiries and concerns. It will be essential for you to stay updated on industry trends and changes in insurance regulations to ensure compliance. To qualify for this role, you should hold a degree in any discipline and have previous experience in medical billing or revenue cycle management. Knowledge of medical billing software and insurance claim processing systems is required, along with a strong understanding of insurance guidelines and reimbursement processes. Excellent communication and interpersonal skills, attention to detail, organizational abilities, and the capacity to multitask and prioritize work will be crucial. Moreover, problem-solving and critical thinking skills, the ability to work independently and as part of a team, familiarity with medical terminology, and proficiency in using Microsoft Office applications are essential for successful performance in this position.,

The position of RCM Quality Analyst in our Revenue Cycle Management (RCM) department in Visakhapatnam, India, is currently open for a detail-oriented and analytical individual. As an RCM Quality Analyst, you will play a crucial role in evaluating and enhancing the quality of revenue cycle processes to ensure accuracy, compliance, and efficiency in all operations. Your responsibilities will revolve around quality and process auditing, data analysis, reporting, feedback and training, continuous improvement, and documentation. Your main tasks will include conducting regular audits to identify discrepancies and areas for improvement, analyzing data to optimize processes, preparing detailed reports for management, providing feedback to the team, and assisting in training initiatives. Moreover, you will collaborate with the RCM team to implement process improvements, maintain accurate documentation, and uphold quality assurance standards. To qualify for this role, you should possess a bachelor's degree in healthcare administration, finance, business, or a related field, along with 2-4 years of experience in revenue cycle management focusing on quality assurance or auditing. Proficiency in RCM software, electronic health records (EHR), and medical billing systems is required, as well as a deep understanding of healthcare billing, coding, and reimbursement processes including ICD-10, CPT, and HCPCS codes. Strong analytical skills, attention to detail, communication skills, problem-solving abilities, and a collaborative approach to teamwork are also essential for success in this role. Additionally, this position offers a fixed night shift, competitive salary, allowances, and insurance benefits. If you are looking to make a meaningful impact in healthcare revenue cycle management and possess the necessary qualifications and skills, we encourage you to apply for the RCM Quality Analyst position and be part of our dynamic team in Visakhapatnam.,

You will be joining Sinex Management Pvt Ltd, a company specializing in providing comprehensive medical billing and revenue cycle management services to healthcare providers. Your primary goal will be to optimize revenue, minimize claim denials, and streamline billing processes to allow medical professionals to focus on patient care. By leveraging the expertise of our billing specialists, you will ensure accurate claim submissions, timely reimbursements, and adherence to industry standards. Our tailored solutions cater to various healthcare settings, such as small clinics, group practices, and independent physicians, to enhance cash flow and reduce administrative burdens. Your role will be a full-time on-site position based in Noida, India. Your responsibilities will include managing daily medical billing tasks, submitting claims accurately, following up with insurance companies, and upholding compliance with industry regulations. You will play a crucial role in reducing claim denials, facilitating timely reimbursements, and safeguarding data confidentiality as per HIPAA guidelines. Additionally, providing exceptional support and solutions to clients will be an integral part of your responsibilities. To excel in this role, you should have experience in medical billing, proficiency in CPT coding and claim processing, and adeptness in insurance follow-ups and reimbursement procedures. Your ability to ensure compliance with industry standards and HIPAA regulations, coupled with strong organizational skills and attention to detail, will be essential. Excellent communication, customer service, and problem-solving skills, along with a proactive approach to addressing client needs, will set you up for success. While relevant qualifications in medical billing or related fields are preferred, your willingness to work on-site in Noida, India is paramount for this position.,