Claims Review Specialist

1 day ago

Hyderabad, Telangana, India beBeeClaims Full time ₹ 10,00,000 - ₹ 19,99,999
Job Title: Claims Review Specialist

We are seeking a skilled Claims Review Specialist to join our team. As an integral part of our organization, you will play a vital role in reviewing and analyzing medical claims to ensure accuracy and compliance with payer guidelines.

  • Your key responsibilities will include reviewing itemized bills and claims for accuracy and completeness, verifying billed services against medical records and documentation, identifying duplicate charges, unbundling, upcoding, or non-covered services, applying payer rules, federal regulations, and internal policies when evaluating charges, comparing charges against contracts, fee schedules, and usual & customary rates, and working on appeals related to billing discrepancies.
  • You will also prepare documentation related to the above protocol, ensuring that all necessary information is accurate and complete.

Qualifications:

  • Certification in medical coding or auditing (CPMA preferred).
  • A minimum of 3-4 years of experience in hospital billing, claims auditing, or insurance claims review.
  • Knowledge of legal and regulatory aspects of healthcare reimbursement.
  • A medical background with MBA/MHA is preferred but not mandatory.

About This Role:

This is an excellent opportunity to utilize your skills and experience in a dynamic and fast-paced environment. If you are passionate about delivering high-quality results and have a strong commitment to excellence, we encourage you to apply.

Key Skills:

  • Medical coding and auditing
  • Hospital billing and claims auditing
  • Insurance claims review
  • Legal and regulatory aspects of healthcare reimbursement
  • Communication and problem-solving skills

What We Offer:

We offer a competitive salary and benefits package, as well as opportunities for professional growth and development. If you are looking for a challenging and rewarding career opportunity, we invite you to apply.

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