Healthcare & Insurance Operations Senior Associate
5 days ago
HC & Insurance Operations Senior Assoc.
- In-depth knowledge and experience in the US healthcare (Non Voice) – Provider Data Validation and Provider Data management.
- Ability to train the team on new process and process updates.
- Calibrate with QA's to ensure process knowledge and variance are managed and under control.
- Ability to create Process SOP, Process Map and identifying the outlier within process.
- Review Discrepancy report and comments, identify gaps and share with TL.
- Identify NVA and provide suggestion for automation opportunities.
- Leads teams to manage day to day inventory
- Monitors QA scores of production resources and performs reviews to improve overall performance
- Floor support to operations and 1st point of level of escalation to client in process, inventory, and performance metrics
- Identify refresher/re-trainable topics, conduct assessments, and certify staff to move to different levels of production.
- Drive team from the front in case of leadership unavailability.
- Need to co-ordinate with quality team to identify the root cause and provide appropriate solution to overcome errors.
- Ensures day-day transactions are processed per standard operating procedures.
- Follows Work process flow to ensure pends are completed and maintain Quality and timeliness standards.
- Knowledge in Amisys and Cenprov application are preferred.
- Product knowledge in checking affiliation for Medicaid, Medicare and Exchange.
- Everyday checked Contract information in Payment Index such as, Pay class, override key, accepts code and etc.
- Ability to read and understand the provider contract.
- Handling Paid claims and recouped claims.
- Claims Rejections handling.
- Working in claims denial management.
- Knowledge about End to End provider billing process.
- Working knowledge in EDI rejection claims
- Handing Patient and provider demographic changes.
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