Claims Examiner

2 days ago


Hyderabad, Telangana, India beBeeMedical Full time ₹ 8,00,000 - ₹ 12,00,000
Job Opportunity

This role involves reviewing and analyzing claims, itemized bills, and medical records to ensure the accuracy of charges, compliance with payer guidelines, and adherence to contractual agreements.

Key Responsibilities
  • Review claims, bills, and supporting documentation for completeness and accuracy.
  • Verify that billed services are supported by medical records and documentation.
  • Identify duplicate charges, unbundling, upcoding, non-covered services, or charges inconsistent with guidelines and billing protocols.
  • Apply relevant laws, regulations, and internal policies when evaluating charges.
  • Compare charges against contracts, fee schedules, and usual & customary rates.
  • Work on appeals related to billing discrepancies.
Requirements
  • Hold a certification in medical coding or auditing (CPMA preferred).
  • Have 3-4 years of experience in hospital billing, claims auditing, or insurance claims review.
  • Be knowledgeable about legal and regulatory aspects of healthcare reimbursement.
  • Possess a medical background with an MBA/MHA (preferred but not mandatory).


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