Job Description

Role & responsibilities Selected trainees Will be trained on Claim adjudication process They will evaluate and processes claims in accordance with company policies and procedures per CMS guidelines/SOP Reviews and analyzes data for in-process claims in order to identify and resolve errors prior to final adjudication Exercises good judgment and remains knowledgeable in related company policies and procedures Achieves teamwork, production and quality standards in order to assure timely, efficient and accurate claims processing Gain knowledge of Commercial, Medicaid, Medicare & TPA claims processing guidelines Knowledge of medical coding/billing including ICD-10, CPT, CMS-1500, UB-04 etc. Knowledge of different providers payment methodologies (i.e., capitation, fee for service based on RBRVS, Medicaid and other negotiated flat rates, RVS pricing, Per Diem, DRG pricing, etc.) preferred Pay or deny per the guidelines/SOP Maintain confidentiality of all information, policies, and procedures as required by the Health Insurance Portability and Accountability Act (HIPAA) protocols Flexibility with shift according to client need is mandatory He/She will report to Team Lead Fresher with good analytical and communication can attempt for Trainee Preferred candidate profile Fresher who can work in NIGHT SHIFTS ( US Shift timings ) Company transport not available Perks and benefits ESI and PF benefits