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  • 0 - 3 Years
  • Posted : above 1 month

Job Description:

Not Applicable


Graduate (exclusion

BE/BTech/MCA) For Medical Management Bachelors degree in Nursing or any health science related field
For NA High School Equiv


Business / Customer

Data Processes

Provide highest level of customer satisfaction
Strive to understand and resolve issues/queries at the first instance
Maintain the business controls as per the requirement

For NA, Medical Management and Benefit Coding

Respond to data requests and generate clientspecified reports in a timely manner
Articulate/ communicate in a manner which is understood by clients / endusers

Claims, RCM and Member Services

Efficiently Process predefined number of claims / enrollment as assigned with highest level of accuracy as agreed upon by the client


Escalating the issues recieved in different batches
Supporting the team to achieve the SLA and TAT associated with Correspondence, Payments, PIA, and Write off
Delivering the quality metrics as defined by Customers

Voice Processes

For Claims, RCM and Member Services

Make and Answer calls to and from customers/end users based on agreed time frames
Transfer calls involving next level of service to the appropriate department as per the given guidelines

Project / Process

Develop a complete understanding of the Procedures
Complete transactions for data preparation, submissions, etc as defined in SOPs
100 PERCENT Process adherence to transaction processing timelines
Adhere to audit compliance ( SAS 70, SOX, Statutory Audit) of all processes as laid out in process documentation
Ensure process guidelines are followed and met as documented
Set productivity /Quality benchmark
Adhere to shift handover processes
Raise process related issues / concerns on time with process and team leads
Ensure to meet all Statistical, Financial and TAT metrics
Stay updated with the process knowledge / changes refer to knowledge updates/ repositories to effectively process transactions
Adhere to security practices set by organization
Provide updates and submit reports related to own area of work
Complete transaction / calls volumes in queue within specified Turn Around Time
Respond to data requests
Perform administrative duties which includes maintaining accurate records of information regarding received claims/treatment requests
Record data relating to production statistics, enduser related notes, etc as appropriate
Maintain confidentiality of all information, policies, and procedures as required by the Health Insurance Portability and Accountability Act (HIPAA) protocols
Raise process related issues/concerns to team leads/manager
Adhere to federal, state, URAC, clientspecified, and established best practices regarding utilization management
Adhere to program quality standards and maintain acceptable levels of performance, including but not limited to attendance, adherence to protocols, customer courtesy, and all other productivity and efficiency targets and objectives
Continuous contribution to process excellence/improvement
Participate in project and organization initiatives led by the Delivery leadership

For Medical Management

Receive, login and file a variety of reports, client charts, client interactions and other documents as needed in the account
Efficiently prepare and/or assign a predefined number of cases/transactions with highest accuracy
Prescreen a claim/treatment request for completeness and determine if this is appropriate for further processing
Sort, upload and assign the claim/treatment request to a case administrator, nurse reviewer or physician reviewer
Follow up on all pending claims appropriately and initiate the next steps

For Claims

Input enrollment/change data in a timely manner to coincide with transmittal to vendors and district payroll
Process claims documents with zero critical errors
Manage benefits documentation by assembling benefit packets, filing benefits paperwork
Read and analyze the Benefit Grid/Source document, understand the benefits and code the same in the application
Works on Blue Exchange, Benefit Narratives and related line of businesses


Follow up on all pending claims appropriately and initiate the next steps
Complete transactions for claims submissions, rejections, Payment posting as defined in SOPs
Complete coding transactions with the required ICD, CPT and other requirements
Respond to data requests
Process claims, charges and coding with zero critical errors

For Provider Services

Review and analysis of the provider application for completeness and accuracy
Perform verification of data through approved sources listed by the client
Collect all pertinent information from the provider, providers malpractice insurer, National Practitioner Data Bank (NPDB) and other sources as listed by the client
Receive and process new and renewal credential applications for a variety of credentials, certificates, Permits and waivers
Make outreaches to providers to collect missing/outdated information
Manage Inventory and work on files that require multiple follow ups with the provider

For Member Services

Process enrollment documents with zero critical errors
Complete enrollment or disenrollment / query calls transactions in queue within specified Turn Around Time

For NA

Develops, coordinates, and executes project plans

People / Team

Contribute to and participate proactively in knowledge sharing sessions
Completes all mandatory assessment/ certifications as applicable
Align individual goals with team objectives (work cohesively with the team)
Participate and contribute to organizational activities
Record own attendance and time sheet related data
Builds and maintains a cohesive cross organization/company project team ethos and fosters productive working relationships, optimally assigning tasks to team members

For NA

Contribute towards updating knowledge assets, user manual, online help document
Contribute to teams Learning and knowledge development programs

Profile Summary:

Employment Type : Full Time
Eligibility : Any Graduate
Industry : Software Services, Internet/Dot com/ISP
Functional Area : Accounting/Tax/Company Secretary/Audit
Role : Audit & Risk
Salary : 200000-400000 P/A
Deadline : 10th Nov 2019

Key Skills:

Company Profile:


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