About the Role - Looking for Claims Auditor in Healthcare - Min 3 Years of experience.
Responsibilities -
- Specifically in Claims adjudication, claims processing, pricing, administrative records review experience pertinent to US Healthcare PAYOR domain
- Medical Records Management, Clinical Audit based on Medical Records Review, Seasoned experience in US Healthcare (Payer/Provider LOB)
- Preferred to have worked over a period of time in US Healthcare payer/provider domain
- Understand the business model for our delivery center and then implement the same in the training vertical
- Should have effective communication skills to coordinate with program SMEs and candidates
- Should be well accustomed with reporting, presentations, creating training materials (videos/document) in granular level
- Should possess understanding of High Cost Drug and Durable Medical equipment auditing through Medical records review
- Previously working for US Healthcare Payer vertical/LOB will be an added advantage
- Follow every aspect of SOP without fail
- Complete received Audits with Quality
- To meet the team/Client Quality and 100% of production target on a daily basis
- Follow project related protocols and instructions
- Escalate issues, identify trends...
- Update all the logs like productivity, Clarification log, and any other logs applicable on a daily basis
- Should be read to extend support working on weekends a and when applicable
- Should be a good team member to ensure the smooth service delivery
- Should be a good and fast learner
- All emails from Leads, Team members, Manager and higher hierarchy should be answered promptly without fail
- Ensure Healthcare compliance of entire team for HIPAA, OIG, PHI etc.
Qualifications - Graduation is mandatory (bachelor's degree)
