Healthcare Specialist

Industry: HealthcareJob Description:We are hiring fresh graduates for the role of Healthcare Specialist to support our US-based healthcare client. The ideal candidate should possess strong communication skills, analytical thinking, and a willingness to build a long-term career in the US Healthcare domain.Key Skills Required:Strong English communication skills (verbal & written)General aptitude and logical reasoningBasic computer proficiency (MS Office, internet usage)Hindi is an added advantage but not mandatoryWillingness to work in night shiftKey Responsibilities 1. Claims Processing and Review Submit, review, and follow up on medical claims to ensure timely reimbursement from insurance payers. Check claim accuracy based on CPT, ICD-10, and HCPCS codes and payer-specific rules. Identify and rectify claim rejections or denials by analyzing Explanation of Benefits (EOB) or Remittance Advice (RA). Work on claim resubmissions, appeals, and corrections as needed. 2. Insurance Verification and Eligibility Checks Contact insurance carriers via phone or online portals to verify patient coverage, benefits, and pre-authorization requirements. Confirm coverage for procedures, diagnostic tests, and treatment plans. Update patient insurance and benefit information in the system accurately. Inform internal teams of insurance-related updates that may impact billing or scheduling. 3. Authorization and Pre-Certification Submit prior authorization requests for services such as diagnostic imaging, surgeries, or therapies. Follow up with insurance companies for approval status. Document approvals, denials, and any additional requirements from payers. Communicate outcomes to providers and ensure necessary paperwork is completed. 4. Revenue Cycle Support Assist in the full RCM process including patient intake, charge entry, payment posting, and AR follow-up. Monitor and manage accounts receivable aging reports. Investigate and resolve delayed or underpaid claims. Maintain accurate records of payment statuses and collection activities. 5. Communication and Coordination Communicate with insurance companies, patients, and provider offices professionally via phone, email, or portal. Clarify insurance requirements, payment responsibilities, and documentation needs. Escalate unresolved issues to supervisors or team leads with complete details. 6. Documentation and Compliance Maintain accurate and complete documentation of all actions taken on patient accounts. Ensure compliance with HIPAA, CMS, and other federal healthcare regulations. Follow internal company policies, security protocols, and data protection guidelines. Participate in audits, reviews, or internal training sessions when required.More information about this Healthcare Specialist - US Healthcare Process JobPlease go through the below FAQs to get all answers related to the given Healthcare Specialist - US Healthcare Process jobWhat are the job requirements to apply for this Healthcare Specialist - US Healthcare Process job position? Ans: A candidate must have a minimum of fresher as an Healthcare Specialist - US Healthcare Process What is the qualification for this job? Ans: The candidate can be a Graduate from any of the following: B.Com, M.Com, MBA/PGDM What is the hiring Process of this job? Ans: The hiring process all depends on the company. Normally for an entry level, hiring the candidate has to go for Aptitude, GD (If they look for communication),Technical test and face to face interviews.This Healthcare Specialist - US Healthcare Process is a work from home job? Ans: No ,its not a Work from Home Job. How many job vacancies are opening for the Healthcare Specialist - US Healthcare Process position? Ans: There are immediate 1 job openings for Healthcare Specialist - US Healthcare Process in our Organisation.

B.Com, M.Com, MBA/PGDM

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