As a technology leader in healthcare process automation and interoperability, Smart Data Solutions (SDS) is a strategic partner that utilizes data and intelligent automation to digitally transform operations and deliver outcomes for clients which reduces costs, streamlines workflows, and improves overall customer experience. Looking to the future, Smart Data Solutions has ambitious growth plans for the next few years and is currently seeking a Product Development Manager to join our team.
What you'll be doing
- Identify , research, process and resolve claims/system edit pends according to desk level procedures (DLP), business guidelines, and quality standards.
- Meet established productivity and timeliness standards to achieve individual and departmental performance goals as defined.
- Capable of investigative and analytical research, demonstrating critical thinking and deductive reasoning
- Manage email proxy boxes and escalation emails as assigned.
- Consult and coordinate with various teams/departments to obtain information to ensure proper and timely resolution of claims/system edit pends.
- Demonstrate a high level of flexibility and adaptability; remain available to transition to different work groups based on business need.
- Employs strong organizational skills, makes good use of work time, and demonstrates an ability to effectively use all available resources to meet established claims processing goals.
- Demonstrate and maintain current working knowledge of the client's systems, procedures, forms, and manuals as applicable.
- Experience with multi-tasking and prioritizing.
- The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
- Adhere to all corporate and client mandatory trainings, privacy and security protocols, time entry requirements , attendance and leave time policies and guidelines.
- Perform all other duties as assigned.
What we're looking for
- Minimum: High School Diploma or equivalent
- Experience using current computer equipment and applications such as laptops and Microsoft Office Suite
- Proficiency with Ten Key and Typing skills.
- Ability to read and interpret Standard Operating Procedure documents and performance / production reporting .
- Intermediate level experience with MS Excel
- 3 years of experience reviewing and interpreting data on medical claim forms.
- Familiarity with medical claim forms CMS1500 and UB04
- Knowledge and experience with Medical Code sets ICD 10, HCPCS, CPT and Modifiers
- Ability to maintain confidentiality and privacy.
- Knowledge of coordination of benefit (COB) principles and terminology.
- 3 year(s) of experience in Health Care claim operations
- Organizational skills and experience prioritizing project work and tasks.
- Experience in the health care industry working with Health Plans or Third-Party Administrators.
- Knowledge and understanding of government products and programs. (i.e. Medicare, Medicaid, etc.)
Why this is the company for you
Top Benefits & Perks
- A company culture that is authentic and values teamwork, humility, and fairness! We work hard for our customers and have fun along the way!
- A professional development and growth-oriented workplace
- Generous benefits
- A good Work-life balance
Who is Smart Data Solutions
Smart Data Solutions is a technology vendor that brings 22 years of healthcare experience using intelligence and automation to extract data from front office mailroom operations. Today, the company is expanding out from its front office focus and targeting its open-source automation and AI engines toward the entire healthcare operations value chain. One of the key benefits of working with Smart Data Solutions is their specialized approach to data capture and automation. Smart Data Solutions takes a comprehensive approach to image and document processing, using multiple engines and hundreds of thousands of lines of code to ensure accuracy and make sense of data. Smart Data Solutions has also invested heavily in EDI interoperability, with clearinghouse capabilities that enable them to pivot towards providing value-added services. Using the data they have collected, they are able to offer population health insights to clients, helping them make informed decisions about their largest areas of spending and identifying potential opportunities for cost savings.
Smart Data Solutions global headquarters are just outside of St. Paul, MN with 400+ employees and leverages dedicated onshore and offshore resources as part of its service delivery model. The company counts over 500 healthcare organizations as clients, including multiple Blue Cross Blue Shield state plans, regional health plans and TPAs, handling over 2 billion transactions of varying types annually with a 98%+ customer retention rate. SDS plans to continue investments into meaningfully in automation and machine learning capabilities across its tech-enabled processes to drive scalability and greater internal operating efficiency while also improving client results.
SDS has partnered with a leading growth-oriented investment firm, Parthenon Capital Partners, and the Blue Venture Fund, a unique collaboration among Blue Cross Blue Shield (BCBS) companies, to further accelerate expansion and product innovation.
Position type and expected hours of work
This is a full-time position. Typical days and hours of work are Monday through Friday, 4:00 p.m. to 1 a.m IST.
Location:
Smart Data Solutions is located in Perungudi,Chennai, TN, India.
Smart Data Solutions is an equal opportunity employer.
All qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, age, marital status, pregnancy, genetic information, or other legally protected status
