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2.0 - 6.0 years
0 Lacs
noida, uttar pradesh
On-site
The ideal candidate for this role should have experience in US Healthcare, Charge Entry, and International Voice Process. As a PE/SPE for Voice/Data in the IT/Computers - Software industry, you will be responsible for handling outsourcing/offshoring tasks in the ITES/BPO/Customer Service sector. This is a full-time, permanent position where you will play a crucial role in the key functions related to US Healthcare, Charge Entry, and International Voice Process. Additionally, the job code for this position is GO/JC/20075/2024, and the recruiter handling this opportunity is Ramya.,
Posted 1 month ago
3.0 - 5.0 years
2 - 4 Lacs
Chennai
Work from Office
Dear Candidate, Greetings from NTT DATA. We are happy to take your profile for a wonderful career with NTT DATA. Job Title: HC & Insurance Senior Associate (Claims Adjudication/Processing) Experience: 3 - 5 Years of relevant experience in Claims adjudication Skillset: HIPAA. ICD, CPT Codes, Medicare, Medicaid, Copay & Coinsurance Shift: Night Shift Work Location: Chennai - DLF Cybercity Mode of Work: Work From Office Positions General Duties and Tasks: • Process Insurance Claims timely and qualitatively • Meet & Exceed Production, Productivity and Quality goals • Review medical documents, policy documents, policy history, Claims history, system notes and apply the trained client level business rules to make appropriate Claims decisions, call out claims trends and flag fraud activities • Analyze customer queries to provide timely response that are detailed and ordered in logical sequencing • Cognitive Skills include language, basic math skills, reasoning ability with excellent written and verbal communication skills • Stay up to date on new policies, processes, and procedures impacting the outcome of Claims processing • Continuous learning to ramp up on the knowledge curve to be the SME and to be compliant with any certification as required to perform the job • Be a team player and work seamlessly with other team members on meeting customer goals • Developing and maintaining a solid working knowledge of the insurance industry and of all products, services and processes performed by Claims function • Handle reporting duties as identified by the team manager • Handle claims processing across multiple products/accounts as per the needs of the business Requirements for this role include: • Both Under Graduates and Post Graduates can apply. • Excellent communication (verbal and written) and customer service skills. • Able to work independently; strong analytic skills. • Detail-oriented; ability to organize and multi-task. • Ability to make decisions. • Required computer skills: must have experience with data entry and word processing, possess a working knowledge of MS Office applications, and understand how to navigate through web-based applications. • Demonstrate strong reading comprehension and writing skills. Cognitive Skills include language, basic math skills, reasoning ability and verbal communication skills. • Ability to work in a team environment. • Handling different Reports - IGO/NIGO and Production/Quality. • To be in a position to handle training for new hires • Work together with the team to come up with process improvements • Strictly monitor the performance of all team members and ensure to report in case of any defaulters. • Encourage the team to exceed their assigned targets. • Candidate should be flexible & support team during crisis period • Should be confident, highly committed and result oriented • Experience on working in an office environment set up utilizing Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools • Experience in a professional/office related role that required you to communicate (oral/written) effectively with internal team members and external customers • Experience in a role that required a focus on quality including attention to detail, accuracy, and accountability for your work product • Candidate should be flexible to work from home and office environment. Broadband connection is must while working from home. Preferences for this role include: • 5+ years of experience processing insurance claims in the health, life, or disability disciplines that required knowledge of CPT, HCPCS, ICD9/10, CDT. • 2+ year(s) of experience in role that required understanding and interpreting complex documents such as medical records and legal contracts. ***Required schedule availability for this position is Monday-Friday 6PM/4AM IST. The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekends basis business requirement.
Posted 1 month ago
1.0 - 4.0 years
3 - 5 Lacs
Hyderabad
Work from Office
Sutherland is hiring Immediate joiners Sutherland is seeking a skilled and experienced RCM Specialist to join our dynamic healthcare team. If you have a strong understanding of physician billing, CMS 1500, and Denial management this is the perfect opportunity to advance our career with global leader in business process transformation AR Calling - For Provider Minimum 12 Months work experience required CTC 3 LPA - 5.5 LPA Looking for Immediate joiners Physician billing, CMS 1500 End to end Denial Experience/ Modifiers/ CPT Codes Night shift/ Fixed week off Mandate WFO, no hybrid Transport radius should be 25KM Contact person: Pyaram Aishwarya Contact number: 9030711720 "Sutherland never requests payment or favor in exchange for job opportunities. Please report suspicious activity immediately to TAHelpdesk@sutherlandglobal.com"
Posted 1 month ago
5.0 - 10.0 years
6 - 12 Lacs
Hyderabad
Work from Office
Job Summary: We are seeking an experienced MRI Technician with a minimum of 7 years of expertise in MRI scanning to join our team. The successful candidate will be responsible for remotely conducting MRI scans for patients in the United States while working from India. This position requires a high level of technical skill, precision in imaging, and a deep understanding of patient care, all while working effectively in a remote setup. Key Responsibilities: MRI Scanning: Perform high-quality MRI scans as prescribed by healthcare providers, ensuring accurate and clear diagnostic images, while adhering to safety and comfort standards for patients. Remote Operation: Operate MRI machines remotely, ensuring clear communication with patients in the US to assist them throughout the scanning process. Provide real-time guidance and support to patients to ensure proper positioning and minimise discomfort. Documentation: Accurately document and update patient records, ensuring all MRI scan data is securely stored and transmitted according to legal, regulatory, and HIPAA standards. Collaboration: Work closely with radiologists, medical professionals, and other healthcare staff based in the US to ensure timely and accurate results. Compliance and Regulations: Ensure compliance with US healthcare protocols, including HIPAA regulations and industry standards for patient confidentiality and safety. Quality Assurance: Conduct routine quality control checks on MRI machines, ensuring that all images meet diagnostic standards. Take proactive steps to maintain machine calibration and troubleshoot any technical issues. Continuous Learning: Stay updated on the latest MRI technologies, techniques, and best practices. Participate in relevant training and professional development activities to enhance skills. Patient Advocacy: Provide exceptional patient care by advocating for their comfort and safety, responding to their needs and concerns, and maintaining a calm, professional demeanor throughout the procedure. Requirements: Qualifications: Associates or Bachelors degree in Radiologic Technology, Medical Imaging, or a related field. Valid MRI certification or specialised training in MRI technology. ARRT (American Registry of Radiologic Technologists) or equivalent MRI certification preferred. Experience: Minimum of 5-7 years of experience as an MRI Technician, with significant expertise in performing MRI scans. Proven experience in a clinical setting, operating MRI machines, and interpreting scan results. Technical Skills: Strong proficiency in operating MRI machines and an understanding of advanced MRI sequences and protocols. Expertise in troubleshooting technical issues and ensuring the equipment functions optimally. Familiarity with US medical imaging practices, radiology workflows, and healthcare systems. Knowledge of HIPAA and other patient confidentiality regulations. Soft Skills: Excellent communication skills for clear patient interactions remotely, both in English and possibly other languages. Strong attention to detail, ensuring the highest level of accuracy and patient safety. Ability to work independently in a remote work environment while managing time and tasks effectively. Empathy and professionalism in patient care, with the ability to reassure patients during the scan process. Strong problem-solving skills and the ability to manage high-pressure situations effectively. Working Hours: This position requires availability to work in US-based time zones, which may include early mornings, late evenings, or weekends, based on patient scheduling needs. Compensation: Competitive salary based on experience, with opportunities for performance-based incentives. Additional benefits may include health insurance, career advancement opportunities, and training allowances.
Posted 1 month ago
1.0 - 3.0 years
4 - 5 Lacs
Pune
Work from Office
Hiring for US Healthcare Process with 1-3 years of International voice experience Excellent English communication skills Hinjewadi location , Night shifts/rotational shift 5-6 lpa Contact- +91 76202 44465
Posted 1 month ago
8.0 - 13.0 years
10 - 20 Lacs
Hyderabad, Pune, Chennai
Work from Office
Seeking a Transition Manager with 7–8 years of relevant experience, including 5+ years in transition roles. Must have 2+ years of hands-on project transition experience and a strong background in US Healthcare processes. Required Candidate profile Work Location - Chennai Shift - US Shifts Call HR Kenedy @ 9620999035 for more details.
Posted 1 month ago
0.0 years
0 - 2 Lacs
Hyderabad
Work from Office
Company Overview: MD Manage (I) Pvt Ltd is a dynamic and growing organization specializing in healthcare management solutions. We are committed to providing exceptional services to our clients and fostering a positive work environment for our employees. Key Responsibilities: - Communicate with insurance carriers to obtain claim information. - Coordinate with doctors' offices to address any queries or issues. - Document call details and relevant information accurately in the company software. - Maintain a clear and professional line of communication with all stakeholders. - Adhere to company policies and procedures while performing daily tasks. Required Skills and Qualifications: - Minimum educational qualification: Under Graduation or Graduation. - Strong verbal communication skills with a professional demeanor. - Basic computer skills for data entry and software management. - Ability to multitask and manage time efficiently in a fast-paced environment. - Prior experience in a similar role is a plus, but not required. Additional Information: - Salary: 18,000 Gross (Net take-home: 16,000) - Meal allowance: 1,500 Sodexo Meals Card monthly - Shift Timing: 5:30 PM - 2:30 AM, Monday to Friday - Fixed weekends off (Saturday & Sunday) - Work Mode: Work from Office from day one - Note: Preference will be given to male candidates. Candidates must submit their 10th original certificate at the time of joining. Interview Details: - Walk-in for interviews from 14th July - 18th July 2025, Monday to Friday, between 3-6pm - Mention company name at entry: MD Manage (I) Pvt Ltd. - Point of Contact: Divya Abbugaru or Srinivas Kathi - Interview Address: HTC Towers, 6-3-1192/V, Kundanbagh Colony, Begumpet, Hyderabad, Telangana.
Posted 1 month ago
2.0 - 3.0 years
1 - 5 Lacs
Hyderabad, Pune, Bengaluru
Hybrid
Job description Hiring for US Healthcare- Claims and premium billing with experience between 2 to 3 years Mandatory Skills: US healthcare, Claims and Billing Education: BE/B.Tech/MCA/M.Tech/MSc./MS Responsibilities A day in the life of an Infoscion As part of the Infosys consulting team, your primary role would be to actively aid the consulting team in different phases of the project including problem definition, effort estimation, diagnosis, solution generation and design and deployment You will explore the alternatives to the recommended solutions based on research that includes literature surveys, information available in public domains, vendor evaluation information, etc. and build POCs You will create requirement specifications from the business needs, define the to-be-processes and detailed functional designs based on requirements. You will support configuring solution requirements on the products; understand if any issues, diagnose the root-cause of such issues, seek clarifications, and then identify and shortlist solution alternatives You will also contribute to unit-level and organizational initiatives with an objective of providing high quality value adding solutions to customers. If you think you fit right in to help our clients navigate their next in their digital transformation journey, this is the place for you!
Posted 1 month ago
10.0 - 17.0 years
25 - 40 Lacs
Noida
Remote
Candidate should have 8+ years of relevant experience in Project Management US Healthcare ,US Hospital ,EMR , EHR,HIS experience is must Interested candidates ,please share resume : ankita.shrivastava@elevancesysyems.com
Posted 1 month ago
1.0 - 4.0 years
3 - 6 Lacs
Chennai
Work from Office
Experience: 1-4 Years Shift: Night Shift (US Time Zones) Job Summary: We are seeking a diligent and detail-oriented Insurance Verification (IV) Caller to join our US Healthcare team. The candidate will be responsible for verifying patients insurance coverage and eligibility by contacting insurance carriers directly, ensuring accurate billing and smooth patient onboarding. Key Responsibilities: Call insurance companies to verify patient eligibility, benefits, coverage details, and authorization requirements. Accurately document verification details such as co-pays, deductibles, co-insurance, plan exclusions, and policy limitations. Coordinate with providers, billing teams, and patients to ensure insurance information is complete and up-to-date. Update patient records with verified insurance data in the system. Meet daily targets for verification volume and quality. Maintain compliance with HIPAA and company policies at all times. Required Skills: Basic understanding of the US healthcare system and insurance verification process. Strong verbal communication and listening skills. Attention to detail and ability to follow protocols accurately. Comfortable working night shifts aligned to US time zones. Experience with EHR/EMR systems and payer portals is an advantage.
Posted 1 month ago
1.0 - 4.0 years
3 - 6 Lacs
Chennai
Work from Office
Experience: 1-4 Years Shift: Night Shift (US Time Zones) Job Summary: We are seeking a skilled Credit Balance Specialist to manage and resolve credit balances and overpayments in the US Healthcare Revenue Cycle Management (RCM) process. The ideal candidate should have strong analytical skills and a good understanding of payer rules and billing practices to ensure accurate resolution of patient and payer credits. Key Responsibilities: Analyze patient and payer accounts with credit balances. Investigate and resolve overpayments, duplicate payments, and incorrect postings. Initiate refund requests or adjustments as per company policy and payer guidelines. Coordinate with billing, AR, and payment posting teams to ensure accurate resolution. Respond to refund audits and payer requests for documentation. Maintain detailed and accurate account notes and audit trails. Ensure compliance with HIPAA and RCM best practices. Required Skills: Strong understanding of US healthcare RCM, especially credit balance and refund processes. Knowledge of payer regulations, billing guidelines, and healthcare terminology. Familiarity with EOBs, remittance advice, and denial codes. Excellent analytical and problem-solving skills. Experience working with billing software (e.g., Epic). Good communication and documentation skills.
Posted 1 month ago
1.0 - 6.0 years
3 - 8 Lacs
Chennai
Work from Office
Experience: Minimum 1 Year Shift: Day Shift Job Summary: We are seeking an experienced Medical Coder specializing in denials management for Radiology and Pathology to join our RCM team. The ideal candidate will be responsible for analyzing denied claims, identifying root causes, and accurately re-coding or appealing based on payer guidelines. Key Responsibilities: Review and analyze denied claims specifically in Radiology and Pathology specialties. Identify coding-related denial reasons and rework claims accordingly. Apply accurate CPT, ICD-10, and HCPCS codes based on medical documentation. Prepare and submit coding appeals with appropriate justifications and references. Collaborate with AR and billing teams for resolution of complex denials. Ensure adherence to compliance standards and payer-specific guidelines. Maintain productivity and quality benchmarks as per company standards. Required Skills: Strong knowledge of Radiology and Pathology coding. Experience handling denials and appeals in a US Healthcare RCM environment. Proficiency with coding tools and systems (e.g., EncoderPro, Optum360, or similar). Familiarity with payer-specific policies and LCD/NCD guidelines. Strong analytical, written, and verbal communication skills.
Posted 1 month ago
2.0 - 4.0 years
3 - 7 Lacs
Noida
Work from Office
Any graduation 2 to 4 years of Years of experience in accounts receivable follow-up / denial management for US healthcare customers Proficient computer skills. Excellent communication skills, both verbal and written Strong people skills & Outstanding organizational skills Ability to maintain the confidentiality of information Willingness to work continuously in night shifts Key Responsibilities: Perform pre-call analysis and check status by calling the payer or using IVR or web portal services Maintain adequate documentation on the client software to send necessary documentation to insurance companies and maintain a clear audit trail for future reference Record aftercall actions and perform post call analysis for the claim follow-up Provide accurate product/ service information to customer, research available documentation including authorization, nursing notes, medical documentation on clients systems, interpret explanation of benefits received etc prior to making the call. Perform analysis of accounts receivable data and understand the reasons for underpayment, days in A/R, top denial reasons, use appropriate codes to be used in documentation of the reasons for denials / underpayments Prepare, review, and transmit claims using AR software, including electronic and paper claim processing Review patient bills for accuracy and completeness and obtain any missing information
Posted 1 month ago
1.0 - 4.0 years
3 - 4 Lacs
Chennai, Bengaluru, Mumbai (All Areas)
Work from Office
Urgent recruitment for AR caller Loc: Chennai, Bangalore, Trichy, Mumbai, Pune Exp: 1 to 4 years Salary: Up to 45,000 Skills: Denial management & Prior authorization Immediate Joiners Preferred Interested Reach: Sangeetha S- 6379093874
Posted 1 month ago
1.0 - 3.0 years
2 - 5 Lacs
Chennai
Work from Office
Hiring for AR Calling - Chennai Walk-in Location: A1 Block, Ground floor, Gateway Office Parks, 16, GST Road, Perungalathur, Chennai - 600 063, Tamil Nadu. Contact us: Sandhiya - 7550106180 - sandhiya.haridass@Sutherlandglobal.com Job Role 1. Reviewing and analyzing claim form 1500 to ensure accurate billing information. 2. Utilizing coding tools like CCI and McKesson to validate and optimize medical codes. 3. Familiarity with payer websites to verify claim status, eligibility, and coverage details. 4. Expertise in various medical specialties such as cardiology, radiology, gastroenterology, pediatrics, emergency medicine, and surgery. 5. Proficiency in using CPT range and modifiers for precise coding and billing. 6. Working with Clearing House systems like Waystar and other e-commerce platforms for claim submissions. 7. Conducting voice-based communication with payers and medical staff to resolve billing discrepancies and facilitate claims processing. Desired Candidate Profile: - 1 Should be a complete Graduate. 2. Comfortable to Sign a Retention Period. 3. Minimum of 2 years of experience in physician revenue cycle management and AR calling. 4. Basic knowledge of claim form 1500 and other healthcare billing forms. 5. Proficiency in medical coding tools such as CCI and McKesson. 6. Familiarity with payer websites and their processes. 7. Expertise in specialties including cardiology, radiology, gastroenterology, pediatrics, orthopedics, emergency medicine, and surgery. 8. Understanding of Clearing House systems like Waystar and e-commerce platforms. 9. Excellent communication skills. 10. Comfortable to Work in Night Shifts. 11. Ready to join immediately Timings & Transport 1. Candidates need to be within the radius of 25 km from Sutherland. 2. Two Way Cab Facility will be provided with in the radius of 25 km from Sutherland. 4. Complete Night Shifts (6:30 PM 3:30 AM) IST. 5. FIVE DAYS WORKING (MONDAY FRIDAY) & SATURDAY, SUNDAY WEEK OFF. 6. Need to be Comfortable with WFO-Work from office. Perks and Benefits 1. Provides Night shift Allowance 2. Saturday and Sunday Fixed Week Offs. 3. Self-transportation bonus upto 3500. Note: "Sutherland never requests payment or favors in exchange for job opportunities. Please report suspicious activity immediately to TAHelpdesk@Sutherlandglobal.com " .
Posted 1 month ago
1.0 - 3.0 years
3 - 5 Lacs
Hyderabad
Work from Office
Detailed job description - Skill Set: Technically strong hands-on Self-driven Good client communication skills Able to work independently and good team player Flexible to work in PST hour(overlap for some hours) Past development experience for Cisco client is preferred.
Posted 1 month ago
1.0 - 5.0 years
1 - 4 Lacs
Chennai
Work from Office
Job highlights 6 months to 4years experience in AR Calling and should be flexible for night shifts. Role & responsibilities An AR (Accounts Receivable) Caller plays a key role in the healthcare revenue cycle, especially in medical billing companies or healthcare provider organizations. Their primary responsibility is to follow up on unpaid medical claims with insurance companies and ensure timely reimbursement. Preferred candidate profile Educational Qualification Graduate or Diploma (any stream); life sciences or commerce background preferred Experience 6months - 5 years of experience in AR calling, specifically in physician billing (professional claims CMS-1500) / hospital billing (UB04). Experience working with US-based insurance companies and understanding of CPT, ICD-10, and modifiers. Preferred Traits Ability to handle high claim volumes. Additional Benefits Fixed week off ( Saturday & Sunday) Two way cab facility at free of cost Location : Chennai Share your CV to below mentioned contact number Vishnu priya S 7358041628 vishnupriya.s4@accesshealthcare.com
Posted 1 month ago
0.0 - 3.0 years
1 - 4 Lacs
Kolkata
Work from Office
Candidates should have Excellent English Communication Skills and Excellent Typing skills. Desired candidate Profile : H.Sc / Graduate freshers with good communication. US healthcare Exp will be an advantage. Knowledge of basic computer operations. Willingness to work in the late evening and night shifts. Courteous with strong customer service orientation. Good listening and speaking skills. Typing speed 30/90% SVAR test mandatory. Work from office only. Do Support process by managing transactions as per required quality standards Fielding all incoming help requests from clients via telephone and/or emails in a courteous manner Document all pertinent end user identification information, including name, department, contact information and nature of problem or issue Update own availability in the RAVE system to ensure productivity of the process Record, track, and document all queries received, problem-solving steps taken and total successful and unsuccessful resolutions Follow standard processes and procedures to resolve all client queries Resolve client queries as per the SLAs defined in the contract Access and maintain internal knowledge bases, resources and frequently asked questions to aid in and provide effective problem resolution to clients Identify and learn appropriate product details to facilitate better client interaction and troubleshooting Document and analyze call logs to spot most occurring trends to prevent future problems Maintain and update self-help documents for customers to speed up resolution time Identify red flags and escalate serious client issues to Team leader in cases of untimely resolution Ensure all product information and disclosures are given to clients before and after the call/email requests Avoids legal challenges by complying with service agreements Deliver excellent customer service through effective diagnosis and troubleshooting of client queries Provide product support and resolution to clients by performing a question diagnosis while guiding users through step-by-step solutions Assist clients with navigating around product menus and facilitate better understanding of product features Troubleshoot all client queries in a user-friendly, courteous and professional manner Maintain logs and records of all customer queries as per the standard procedures and guidelines Accurately process and record all incoming call and email using the designated tracking software Offer alternative solutions to clients (where appropriate) with the objective of retaining customers and clients business Organize ideas and effectively communicate oral messages appropriate to listeners and situations Follow up and make scheduled call backs to customers to record feedback and ensure compliance to contract /SLAs Build capability to ensure operational excellence and maintain superior customer service levels of the existing account/client Undertake product trainings to stay current with product features, changes and updates Enroll in product specific and any other trainings per client requirements/recommendations Partner with team leaders to brainstorm and identify training themes and learning issues to better serve the client Update job knowledge by participating in self learning opportunities and maintaining personal networks Mandatory Skills: Member Inbound.
Posted 1 month ago
5.0 - 8.0 years
8 - 12 Lacs
Hyderabad
Work from Office
Required Skills & Experience: 7+ years of QA experience, with 5+ years in Facets US Healthcare Experience especially in Claims processing, Membership, Providers and Utilization Managemen Strong experience with Facets application testing (UI, DB and Batch) Hands-on experience with Facets Modernization projects Familiarity with tools like JIRA or Rall Excellent communication and leadership skills. Experience: Preferred Skills Experience with Apache Airflow (nice to have) Knowledge of cloud platforms and migration strategies Certification in QA methodologies or Agile practices Mandatory Skills: HC - Payor. Experience:5-8 Years.
Posted 1 month ago
0.0 - 1.0 years
1 - 4 Lacs
Pune
Work from Office
MedeXCode is looking for Medical Coder Fresher Non Certified to join our dynamic team and embark on a rewarding career journeyReview clinical documents and assign standardized medical codes using ICD-10, CPT, and HCPCS systems for diagnoses, procedures, and services. Ensure coding accuracy and compliance with healthcare regulations and payer policies. Collaborate with healthcare providers to clarify documentation, support billing and reimbursement processes, and help reduce claim denials. Maintain confidentiality and adhere to data security protocols.
Posted 1 month ago
2.0 - 5.0 years
3 - 7 Lacs
Pune
Work from Office
Davies is seeking a highly organised and self-motivated professional to join our Life & Health team as an Administrator Team Leader. In this role, you will provide leadership, guidance, and direction to a dedicated team, ensuring the achievement of key results and operational excellence. Your responsibilities will include overseeing document indexing, imaging, quality audits, data entry and the review of Proof of Loss (POL), as well as processing policy documents and claims. You will play a critical role in handling sensitive files and processing essential documents to support our US operations. This is an excellent opportunity for a proactive and detail-oriented individual looking to make an impact within a dynamic and collaborative environment.
Posted 1 month ago
5.0 - 10.0 years
5 - 6 Lacs
Noida
Work from Office
About Us: Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member s performance objectives as outlined by the Team Member s immediate Leadership Team Member. Roles and Responsibilities: Perform pre-call analysis and check status by calling the payer or using IVR or web portal services. Maintain adequate documentation on the client software to send necessary documentation to insurance companies and maintain a clear audit trail for future reference. Record after-call actions and perform post call analysis for the claim follow-up. Assess and resolve enquiries, requests and complaints through calling to ensure that customer enquiries are resolved at first point of contact. Provide accurate product/ service information to customer, research available documentation including authorization, nursing notes, medical documentation on clients systems, interpret explanation of benefits received etc prior to making the call. Perform analysis of accounts receivable data and understand the reasons for underpayment, days in A/R, top denial reasons, use appropriate codes to be used in documentation of the reasons for denials / underpayments. Prepare, review, and transmit claims using AR software, including electronic and paper claim processing. Review patient bills for accuracy and completeness and obtain any missing information. Required Expertise & Qualification: 12th Pass/Graduate in any discipline 8 months - 5 years of Years of experience in accounts receivable follow-up / denial management for US healthcare customers. Proficient computer skills. Excellent communication skills, both verbal and written. Strong people skills & Outstanding organizational skills. Ability to maintain the confidentiality of information. Willingness to work continuously in night shifts PHYSICAL DEMANDS: Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines. A job description is only intended as a guideline and is only part of the Team Member s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Posted 1 month ago
3.0 - 8.0 years
15 - 20 Lacs
Noida
Work from Office
Company: Mercer Description: POSITION: Health Consulting Analyst INTERNAL DETAILS Job family: H&B Consulting / Job family group: Consulting Job profile: H&B Consulting Analyst Aligns to US-based role of Level D WHAT A TYPICAL DAY LOOKS LIKE Assist associates and lead consultants in serving our clients by reviewing client needs, recommending suitable approaches, and helping implement benefit program strategies Become steeped in the details and documentation of a clients current state of US healthcare benefit and group programs, such as plan designs, healthcare cost factors, the carrier contract marketing and renewal processes, compliance reporting and open enrollment periods Draft and structure communications and collateral such as client emails, proposals, letters, reports, spreadsheets, and presentations Analyze, benchmark and compare and contrast healthcare data and then interpret results and present insights to the core team Aid in developing open enrollment benefit guides Engage with client vendors regarding client deliverables, documentation and data, and issue resolution Project manage and coordinate with internal stakeholders from specialty teams and centers of excellence to stay on top of client deliverables Coordinate with actuaries to ensure they have all data required for their underwriting and that their inputs are accurately captured in client materials Monitor day-to-day client interactions and offer support or escalate appropriately Support with client compliance requirements Manage and maintain client documentation and data files Use Mercer s proprietary tools, templates and best practices Interact daily with US-based core client team members WHAT WE VALUE Excellent interpersonal, verbal, and written communication skills with an aptitude for presentation design and storytelling Strong analytical skills, both quantitative and qualitative, with the ability to articulate useful and noteworthy insights Competency in project management and superior organizational skills Intellectual curiosity; seeking opportunities to develop new skills and to deepen knowledge of the US Healthcare industry Ability to work in teams and independently across multiple clients Flexibility to work under tight deadlines and changing client needs Strong attention to detail PREFERRED QUALIFICATIONS Prior 3+ years of work experience Prior experience in the US Healthcare industry A bachelors degree with concentration(s) in business, math, statistics, economics, public health, and/or other related field is preferred Working knowledge of Microsoft Office Word, Excel, and PowerPoint Desired work-shift 07:30 - 01:30 IST for significant overlap with US-based colleagues WHAT MAKES YOU STAND OUT Experience working directly with US-based clients Track record of critical thinking beyond standard operating procedures Proven flair for building and sustaining relationships with onshore (US-based) colleagues Proven fast learner with a knack for taking initiative and emulating from example
Posted 1 month ago
5.0 - 7.0 years
8 - 12 Lacs
Kolkata, Mumbai, New Delhi
Work from Office
Job Description Coordinates all aspects of a product or service offering project for a client, from inception to installation. Installations may involve acceptance of capitalized equipment or enterprise software systems, or system integration or consulting projects/engagements. May work at client site from time to time. Typically involves extensive interaction with sales, systems engineering, product development and other members of cross-functional teams. Project is typically focused on the delivery of new or enhanced products to improvement of customer satisfaction through the use of technology. Project management skills, rather than technical skills, are key, but a strong technical background is often required to manage competing interests. Typically oversees schedules and budgets to ensure goal attainment. This role is most common in a software or professional services organization in which the individual does not have responsibility over product development, but does have overall project management responsibility. Roles & Responsibilities The Project Manager works with all functional areas within Client Engagement Services to create and maintain project plans (provider engagement plans) for multiple health plan implementations and add-on implementations and ensure tasks are completed on time. This position coordinates with all levels of Availity management, Program Management, Account Management, Growth, Product, and other internal departments on release dates, requests, CRs, and scope needed to accomplish project tasks. The Project Manager leads provider engagement meetings and consults with health plan clients, which may include all levels of leadership. This position will follow up on any escalations, questions, or issues resulting from the meeting or project. The Project Manager may also attend other related meetings and manage learning projects. This position manages admin features and the intake process in Smartsheets, our project management software, and creates dashboards to communicate project statuses and resource management to leadership. The Project Manager may assist with the analysis of project and operational data to align the outcome of projects with Availity strategic, product, and business goals. The Project Manager must have excellent communication and presentation skills and the ability to relate to clients at the project level and leadership level. The Project Manager will also be required to perform other duties, projects, or activities as specified by their management . WORK EXPERIENCE REQUIRED 5 7 years of experience in Project Management EDUCATION AND CERTIFICATION REQUIRED Bachelor s Degree in Business or related discipline or 5 - 7 years of Project Management experience in lieu of a degree SPECIALIZED SKILLS AND KNOWLEDGE Experience managing medium and large-scale projects Experience with Smartsheet or other project management software (prefer Smartsheet) Excellent written and oral communication skills Excellent relationship management skills Excellent interpersonal skills; proven experience working as both a leader and member of a team Familiarity or experience in a healthcare or learning environment a plus Familiarity with Salesforce or Jira a plus
Posted 1 month ago
1.0 - 5.0 years
0 - 0 Lacs
bangalore, chennai, mumbai city
On-site
We're Hiring! AR Callers & Senior AR Callers!!!! Locations: Chennai | Hyderabad | Bangalore | Mumbai | Pune Do you have 1+ year of experience in AR Calling We want to hear from you! Role Highlights: Salary: based on performance Work Mode: Work from Office Join Immediately: Immediate joiners preferred, WFO Relieving Letter: Not mandatory Reach out TO kEERTHANA 9356775532(Call or WhatsApp) Share your resume today! Referrals are appreciated help someone find their next opportunity!
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