Medical Summarizer
5 days ago
Key Skills: Ability to review and analyze complex medical documentation with a high degree of accuracy to prevent errors in claims processing and familiarity with medical coding systems (CPT, ICD, HCPCS) to understand and interpret medical procedures and diagnoses.
SUMMARY:
o A Healthcare Complex Claims Specialist is responsible for the thorough investigation, adjudication, and processing of complex healthcare claims in adherence to industry regulations and organizational policies. This role requires a deep understanding of analyzing medical records, healthcare coding systems (e.g., CPT, ICD-10, HCPCS) to accurately assess claims.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.
o Ability to review and analyze complex medical documentation with a high degree of accuracy to prevent errors in claims processing.
o Evaluate claims against established guidelines, contracts, and regulatory requirements.
o Conduct detailed research on complex claims, pre-existing conditions, and other intricate scenarios.
o Analyze medical records, policy documents, and other relevant information to make informed claim decisions.
o Demonstrate proficiency in healthcare coding systems (e.g., CPT, ICD-10, HCPCS, Revenue codes, medical terminologies, Human Anatomy, Inpatient Vs. Outpatient claims) to accurately assess claims.
o Apply knowledge of healthcare benefits and payment policies.
o Provide clear and concise explanations of claim decisions to relevant parties.
o Identify trends and patterns in complex claims to contribute to process improvements.
o Candidate should be able to correctly calculate claim amounts for the customers.
o Complying with company regulations regarding HIPAA, confidentiality, and private health information.
QUALIFICATIONS:
o Medical Graduates – MBBS, Physiotherapists, B-Pharma or life science graduates with minimum 1 year of experience in handling US Health Insurance claims.
o Graduates having have a minimum of 3 years of experience in handling US HI claims.
LANGUAGE SKILLS:
o Should have strong English comprehension, verbal and written skills
o Strong medical science knowledge to comprehend medical reports
MATHEMATICAL SKILLS:
o Should have basic math knowledge of calculating simple interest, compound interest.
REASONING ABILITY:
o Should have good English comprehension and analytical skills
o Should have excellent problem-solving skills with an eye for detail
WORK ENVIRONMENT:
o Should be open to work 24*7 and mandatory US timings, night shift
Ready to handle work pressure and ensure deliverables within timelines
Job Type: Full-time
Benefits:
- Health insurance
- Provident Fund
- Work from home
Work Location: Remote
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