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Senior Executive-Auditors-Datamining

0 years

0 Lacs

chennai tamil nadu india

Posted:1 day ago| Platform: Linkedin logo

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Skills Required

processing analyze healthcare calculations optimization data analysis management inventory reports communication coordination resolve compliance integrity efficiency

Work Mode

On-site

Job Type

Full Time

Job Description

Claims Processing & Adjudication

Review, analyze, and process healthcare claims accurately based on payer rules, policy guidelines, and contractual terms.Perform manual payment determination and allowable calculations without relying on system tools.

Revenue Optimization & Data Mining

Identify gaps, underpayments, and missed revenue opportunities through data analysis and claims review.Support data mining programs by providing insights for revenue realization and process improvement.

Quality & Productivity Management

Ensure all assigned claims inventory is completed within defined TAT while maintaining required quality standards.Prepare and update production, quality, and status reports regularly as per business requirements.

Communication & Coordination

Maintain clear and professional communication with internal teams and stakeholders.Participate actively in meetings, calls, and discussions as required to resolve claim or process-related issues.

Compliance & Process Adherence

Follow all compliance protocols, company policies, and HIPAA guidelines without fail.Ensure data confidentiality and integrity are maintained at all times.

Independence & Initiative

Work independently with minimal supervision, demonstrating accountability and ownership for assigned tasks.Contribute proactively to process improvement and efficiency initiatives.

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