Transaction Quality Assurance Associate

2 weeks ago

Coimbatore Tamil Nadu, India NTT DATA Full time

**In this Role you will be Responsible For**
- Experienced level adjudicator providing analytical ability to review claim rules and workflows.
- Reviews claim requests to determine eligibility for processing and escalate to management as necessary.
- Responsible for the coordination and resolution of the administrative denials and appeals
- Ability to understand logic of standard medical coding (i.e. CPT, ICD-10, HCPCS, etc.).
- Ability to resolve claims that require adjustments and adjustment projects, Identify claim(s) with inaccurate data or claims that require review by appropriate team members.
- Organizing and completing tasks per assigned priorities.
- Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team
- Resolving complex situations following pre-established guidelines
- Assists with transaction processing and detects errors in transaction.
- Performs transactional quality based on audit parameters.
- Classifies errors based on the type of the error and assigns root causes for errors.

**Requirements for this role include**:

- University degree or equivalent that required formal studies of the English language and basic Math
- 1+ year(s) of experience processing and performed quality audit of claims for the US healthcare market
- 6+ months of data entry experience that required a focus on quality including attention to detail, accuracy, and accountability for your work product.
- 6+ months of experience that required prioritizing your workload to meet deadlines

***Required schedule availability for this position is Monday-Friday 6PM/4AM IST The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend's basis business requirement.

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