Appeals Specialist

2 weeks ago

Hyderabad, India PrimEra Medical Technologies Full time
Summary: This position is responsible for reviewing, analyzing, and validating claims, itemized bills and medical records to ensure accuracy of charges, compliance with payer guidelines, and adherence to contractual agreements.
Responsibilities:
• Review itemized bills, claims, and supporting documentation for accuracy and completeness.
• Verify that billed services, procedures, and supplies are supported by medical records and documentation.
• Identify duplicate charges, unbundling, upcoding, non-covered services, or charges inconsistent with guidelines and billing protocol.
• Apply payer rules, federal/state regulations, and internal policies when evaluating charges.
• Compare charges against contracts, fee schedules, and usual & customary rates.
• Work on appeals related to billing discrepancies.
• Create documentation related to the above protocol.
Qualifications:
• Certification in medical coding or auditing - CPMA (preferred), CPC, CCS, COC, etc.
• 3-4 years of experience in hospital billing, claims auditing, or insurance claims review.
• Knowledge of legal and regulatory aspects of healthcare reimbursement.
• Medical background with MBA/MHA preferrable, but not mandated
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