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Claims Analyst

Keywords / Skills : US Healthcare, Payer, Claims Adjudication, Payment validation

1 - 6 years
Posted: 2019-05-15

Nationality
India
Industry
ITES/BPO
Function
Customer Service/Call Centre/BPO
Role
Customer Service Executive (Non-voice)
Education
Any graduate
Posted On
15th May 2019
Job Description
Designation : Claims Analyst & Sr Claims Analyst

Domain US Healthcare Payer

Experience : 1.5 Years +

Work Location : Hyderabad

CTC : Upto 4 L (Depends on Current CTC & Performance )

Job Description:

Retrospective claim review & analysis to verify payment accuracy and identify incorrect claim reimbursements

Payer-Provider Contract compliance analysis & assessment of claims for payment integrity, in accordance with the terms of the agreement

Identification and correction of contract management issues, providing critical insights into the complex payer contracts affecting the provider reimbursement.

Identify billing & coding inconsistencies resulting in denials/incorrect payments, and take measures to rectify these retroactively

Research & analyze facility (UB-04) claims for possible payment variances, and take corrective action to receive the appropriate claim reimbursement

Identify & validate the payment variance and re-file/appeal the claims

Should have Experience into over payment and payment validation

Follow up with Insurance companies on behalf of hospitals on the potential underpayments

Recover the underpaid amount on behalf of the provider

Stay abreast of Medicare, Medicaid & Commercial insurers billing, coding & payment guidelines

Desired Candidate Profile:

US Healthcare experience on at least one of the following is a pre-requisite

Facility Claims adjudication experience of at least 1 years

Facility claims AR/Denial analysis experience for a period of 18 months

Over payment identification & recovery experience of 12-18 months

Contract review experience

Contract/member benefits modeling experience

Credit balancing experience

Healthcare Claims Audit & analysis

Good knowledge on Medicaid and Medicare payment methodologies

Expertise to understand payer remittance advice(RA)/ Explanation of benefits(EOB)

Expertise to understand payer contract to validate payments

Knowledge on resolving payer denials(Medicare, Medicaid & Commercial)

An inclination to research, analyze & investigate

Ability to think beyond transaction/guidelines based activities, and aspire for high-end audit & analytical activities

To review the appeals and grievances

If you are interested please share your updated resume to [HIDDEN TEXT] OR Contact - 8277265109

Thanks & Regards,

Devika
Vibrant HR

About Company

Welcome........


Vibrant HR Consultancy Services is a professional recruitment firm catering to the needs of various companies across verticals. Vibrant is based out of Bangalore & services clients across India. Since our inception, we have been in the business scenario with a mission of serving the companies with the speed and quality that is required.
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