Appeals Specialist

4 weeks ago


Hyderabad, Telangana, 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

Please share your resumes at mvuyyala@primehealthcare.com
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