Executive-Claims Management-Medical Billing and Claims Processing

1 day ago

Noida, Uttar Pradesh, India EXL Full time ₹ 9,00,000 - ₹ 12,00,000 per year
Description
  • Responsible to reprice the non-par claims as per the Fee schedule and payment methodology.
  • Conduct primary and secondary reviews of medical claims to verify correct reimbursement calculations based on costs, Medicare, or a usual and customary methodology in accordance with self-funded benefit plan language.
  • Use Microsoft Office products to generate letters, explanations, and reports to explain medical reimbursement approaches and communicate this information.
  • Provide input for new process development and continuous improvement.
  • Supplier will share daily production report with stateside manager for review and feedback.
  • Maestro Health will provide all applications and accesses required for claim repricing.
  • Access requests should be completed within first week of project start date in order to start production.
  • Requirement gathering & training session will require active participation from Maestro Health manager.

Software/System licensing will be charged to the cost center directly vs. invoiced by Supplier.

Skills Required:

  • Graduate with good written and oral English language skills
  • Expertise in using Claim processing and validation application and worked in past on same profile/portfolio.
  • Basic level proficiency on Excel to query production data and prepare/generate reports.
  • Analytical mindset with strong problem solving skills.
  • US Healthcare insurance domain experience desirable
  • Understanding of US Healthcare system terminology, understanding of claims, complaints, appeals and grievance processes.
Responsibilities

Understand PMS and client PMS systems: Familiarity with Property Management Systems (PMS).
RCM Payment Posting: Experience with both manual and electronic payment posting, accounts receivable (AR), correspondence, and denial capture.
Thorough understanding of US Healthcare RCM: Expertise in payment posting, AR, correspondence, and denial capture within the US healthcare revenue cycle management.

Qualifications

Graduate in stream preferred science stream 1 - 2 Years

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