SHAI

Company Description At SHAI, we empower our healthcare customers to excel in what they do. Our clients consistently appreciate the seamless support, collaboration, and added value we bring to their business. With 30 years of industry experience, we have perfected the art of blending technology, thought leadership, and execution to make a meaningful impact in everything we deliver. Role Description This is a full-time on-site role for an IPDRG at SHAI, located in Chennai. The IPDRG will be responsible for analyzing and interpreting healthcare data, coding patient information, ensuring compliance with healthcare regulations, and maintaining accurate electronic health records. Daily tasks include collaborating with healthcare teams, conducting data verification, and preparing reports. The role requires attention to detail and adherence to industry standards. Qualifications Proficiency in data analysis and interpretation Experience in medical coding and maintaining electronic health records Knowledge of healthcare regulations and compliance standards Strong analytical skills and attention to detail Excellent communication and collaboration abilities A bachelor’s degree in Health Information Management, Healthcare Administration, or a related field Prior experience in the healthcare industry is a plus Show more Show less

Job Description: We are looking for a motivated and detail-oriented Utilization Management Specialist to join our team. As a fresher In this role, you will help review medical information to ensure that healthcare services are necessary and follow best practices. You will support the approval of healthcare services to ensure they are cost-effective and meet patient needs. Key Functions: Review outpatient procedures, inpatient admissions, home health, and behavioral health services to check if they are necessary. Work with providers and medical directors to get prior authorization and plan for case reviews when needed. Collaborate with clinical staff to ensure appropriate care and resource use. Participate in quality improvement projects and help develop clinical guidelines. Monitor and report on utilization trends to management Requirements Preferred Skills Familiarity with MCG/Inter Qual Guidelines is a plus. Keep up-to-date with regulations and maintain organized records of all activities. Experience with Medicaid, Medicare, and Managed Care is helpful. Strong knowledge of anatomy, physiology, and medical terminology. Proficient in MS Office applications. Excellent communication skills and ability to work both independently and in a team. Strong analytical and problem-solving skills. Qualifications : Candidates with a Bachelor's Degree in Nursing are eligible to apply Freshers can also apply. Candidates already having work experience in the Hospital Field is added advantage. Benefits Perks and Benefits Five Days of working Saturday and Sunday fixed Week off Double Wages (If working on Saturday/Sunday) Both 2-way Cab facility Available for only Night Shift

We are seeking a motivated and detail-oriented Utilization Management Specialist to join our team. In this role, you will play a crucial part in reviewing medical information to ensure the necessity of healthcare services and adherence to best practices. Your responsibilities will include supporting the approval of cost-effective healthcare services that align with patient needs. You will be tasked with reviewing outpatient procedures, inpatient admissions, home health, and behavioral health services to determine their necessity. Collaborating with providers and medical directors to obtain prior authorization and plan case reviews when necessary will be an essential aspect of your role. Additionally, working closely with clinical staff to guarantee appropriate care and resource utilization is vital. As a Utilization Management Specialist, you will actively participate in quality improvement projects and contribute to the development of clinical guidelines. Monitoring and reporting on utilization trends to management will be a key responsibility to ensure efficient healthcare service delivery. Preferred Skills for this role include familiarity with MCG/Inter Qual Guidelines, up-to-date knowledge of regulations, and maintaining well-organized records of all activities. Experience with Medicaid, Medicare, and Managed Care is advantageous, along with a strong understanding of anatomy, physiology, and medical terminology. Proficiency in MS Office applications, excellent communication skills for effective teamwork, and the ability to work both independently and collaboratively are essential. Strong analytical and problem-solving skills are also desirable. Candidates applying for this position should hold a Bachelor's Degree in Nursing, while freshers are encouraged to apply. Previous work experience in the Hospital Field is considered an added advantage. Benefits offered for this position include a five-day workweek, with fixed weekends off (Saturday and Sunday). Employees working on weekends are eligible for double wages, and a two-way cab facility is available for night shifts.,

Training Development & Delivery: Develop comprehensive training materials, including manuals, slides, and quizzes, to support medical coding education. Conduct hands-on training for new coders, covering essential coding systems (ICD-10, CPT, HCPCS), coding software, and billing procedures. Provide refresher courses and ongoing education for current coders to ensure they are up-to-date with the latest coding guidelines and regulations. Utilize various teaching methods such as lectures, workshops, webinars, and e-learning modules to accommodate different learning styles. Trainer for Coding Accuracy & Compliance: Ensure all trainees and coders understand and adhere to current coding standards, including HIPAA compliance, Medicare and Medicaid rules, and payer-specific requirements. Monitor and assess coder performance through coding audits, assessments, and practical evaluations. Provide one-on-one coaching and mentoring to coders, addressing areas of difficulty and improving coding accuracy and productivity. Facilitate problem-solving sessions to resolve complex coding issues. Ongoing Support & Troubleshooting: Act as a point of contact for coders who need assistance with coding queries, case reviews, and technical troubleshooting. Offer continuous support to coders, answering questions related to coding guidelines, regulatory changes, and coding best practices. Stay current on updates to ICD-10, CPT, HCPCS codes, and other relevant coding systems to ensure that all coders are working with the most up-to-date information. Quality Control & Performance Monitoring: Conduct regular audits of coder work to ensure the accuracy of code selection, proper documentation, and adherence to payer policies. Provide detailed feedback to coders and supervisors on coding accuracy, compliance, and areas for improvement. Review and analyze coding errors to identify trends and root causes, implementing corrective actions as needed. Documentation & Reporting: Track and document coder progress through training sessions, assessments, and audits. Prepare reports on coder performance, training outcomes, and areas for improvement for management. Maintain records of training activities, certifications, and compliance with industry standards. Continuous Learning & Industry Updates: Attend workshops, webinars, and conferences to stay informed about the latest coding trends, regulatory changes, and software tools. Incorporate new coding standards, changes in healthcare policies, and industry updates into training materials and programs. Share insights with team members to foster a culture of continuous learning. Collaborate with Team Members: Work closely with coding supervisors, managers, and other departments to ensure that training programs align with organizational needs and compliance requirements. Participate in team meetings to provide feedback and collaborate on process improvements for training and coding operations. Requirements Education and Experience: High school diploma or equivalent; an Associate's or Bachelor's degree in Health Information Management, Medical Billing and Coding, or a related field is preferred. Certified Professional Coder (CPC) from AAPC or Certified Coding Specialist (CCS) from AHIMA is required. A minimum of 6 years of experience in medical coding, with at least 2 years of experience in a training or mentoring role. Experience with medical coding software and electronic health record (EHR) systems is highly desirable. Knowledge and Skills: Strong knowledge of ICD-10, CPT, HCPCS coding systems, and medical terminology. In-depth understanding of federal and state healthcare regulations, including HIPAA, Medicare, and Medicaid coding requirements. Proven ability to design, develop, and deliver effective training programs. Excellent verbal and written communication skills, with the ability to explain complex topics in simple terms. Strong organizational skills and the ability to manage multiple tasks or projects simultaneously. Ability to work with diverse teams and provide constructive feedback to improve performance.

ob Title: HCC Coder Location: Chennai Job Type: Full-time Job Summary: We are seeking a detail-oriented and knowledgeable HCC Coder with 12 years of experience to join our healthcare team. The successful candidate will be responsible for reviewing medical records and assigning accurate diagnosis codes to support risk adjustment and proper reimbursement in accordance with CMS HCC risk adjustment guidelines. Key Responsibilities: Review and analyze medical records to assign accurate ICD-10-CM diagnosis codes in accordance with official coding guidelines and HCC risk adjustment models. Ensure all coded data meets CMS, Medicare Advantage, and company compliance standards. Identify missing or incomplete documentation and communicate with providers for clarification when needed. Validate HCC codes and ensure risk-adjusted conditions are captured appropriately for each patient encounter. Maintain confidentiality of all patient health information in compliance with HIPAA regulations. Meet daily/weekly production and accuracy targets set by management. Participate in audits, compliance reviews, and training updates. Qualifications: 12 years of experience in medical coding, specifically in HCC/Risk Adjustment. Certification required: CPC, CRC, CCS, or equivalent (AHIMA or AAPC credential). Solid understanding of HCC coding principles and risk adjustment models (CMS-HCC, HHS-HCC, etc.). Familiarity with electronic health records (EHR) and coding software/tools. Strong knowledge of ICD-10-CM coding guidelines. Excellent attention to detail, time management, and analytical skills.

Role Overview: You will be responsible for developing comprehensive training materials, conducting hands-on training sessions, providing refresher courses, and utilizing various teaching methods to support medical coding education. Additionally, you will monitor and assess coder performance, offer ongoing support, and troubleshoot coding queries. Your role will also involve providing detailed feedback, tracking coder progress, preparing reports, staying updated on industry trends, and collaborating with team members. Key Responsibilities: - Develop training materials such as manuals, slides, and quizzes to support medical coding education - Conduct hands-on training for new coders on essential coding systems, software, and billing procedures - Provide refresher courses and ongoing education for current coders - Utilize various teaching methods to accommodate different learning styles - Monitor and assess coder performance through coding audits and assessments - Provide one-on-one coaching and mentoring to improve coding accuracy and productivity - Act as a point of contact for coders needing assistance with coding queries - Offer continuous support, answer questions related to coding guidelines, and stay updated on coding systems - Provide detailed feedback to coders and supervisors on coding accuracy and compliance - Review and analyze coding errors to implement corrective actions - Track and document coder progress through training sessions and audits - Prepare reports on coder performance and training outcomes - Attend workshops, webinars, and conferences to stay informed about industry updates - Collaborate with coding supervisors, managers, and other departments to align training programs with organizational needs Qualifications Required: - High school diploma or equivalent; Associates or Bachelors degree in Health Information Management, Medical Billing and Coding preferred - Certified Professional Coder (CPC) from AAPC or Certified Coding Specialist (CCS) from AHIMA required - Minimum 6 years of experience in medical coding, with at least 2 years in a training or mentoring role - Experience with medical coding software and electronic health record (EHR) systems highly desirable - Strong knowledge of ICD-10, CPT, HCPCS coding systems, and medical terminology - In-depth understanding of federal and state healthcare regulations - Proven ability to design, develop, and deliver effective training programs - Excellent verbal and written communication skills - Strong organizational skills and ability to manage multiple tasks - Ability to work with diverse teams and provide constructive feedback for performance improvements,