Basic Function
This position is responsible for reviewing, analyzing and interpreting medical Information to assess and determine appropriate next action steps which may lead to denial or payment of claims.
Work is performed under general supervision according to established guidelines. This individual promotes capabilities from a customer perspective, aligning needs with the target offering by creating a customer self-service enabled platform for core customers.
Essential Functions
- Responsible for reviewing and analyzing discrepancies by cross-verifying from different data sources
- Familiar with US Healthcare domain knowledge and understanding of healthcare regulations (HIPAA)
- Deep understanding of medical coding, billing, and medical terminologies
- Attention for detail, and Strong analytical skills for processing medical documentation
- Critical thinking and high independent decision making capability
- Proficiency in healthcare information systems
- Ability to navigate through multiple applications
- Operates with urgency in a real time service environment
- Meets individual goals while assisting team to meet team goals
- Defines, communicates and manages workflow and data coordination to support various implementation related reports (i.e., reporting, inventory, capacity reporting, and ad-hoc reports as needed by management)
- May perform other duties as assigned
Performance parameters
- Productivity
- Quality
- Turn Around Time of work assigned
- Attendance & Schedule Adherence
Primary Internal Interactions
- SME/AM/LAM/Manager for the purpose of reporting performance, escalation handling, clarifying concerns, and seeking support
- AM/LAM for the purpose of settling issues left unresolved by the SME and monthly evaluation of performance
- SME for the purpose of handling process related issues; queries and escalated transactions
- QCA for the purpose of associate performance feedback and audit in order to update the training curriculum
- Mentors for the purpose of seeking clarifications and answering queries real time
