Assistant Manager/ Manager

  • Noida
  • Confidential
  • 5-10 years
  • Views
  • 24 May 2018

  • Customer Service

  • BPO/ ITES/ Call Centers
Job Description

Role Overview: - Good understanding of US Healthcare Payer Claims - Experience in audit of workers compensation medical bills - Strong understanding of CMS & State payment policies - Expert in State Fee Schedules and payment hierarchy - Good analytical and communication skills Responsibilities: - Serve as subject matter expert and analyze claims payments as per state workers compensation guidelines - Quality audit of workers compensation medical bill payments - Responsible for the accurate and thorough investigation of potential fraud and abuse involving workers compensation - Provide ideas to technical team of potential overpayment cases - Documentation of provider communication - Proactively gather feedback from users - Quick turnaround using logical understanding of data - Tracking and reporting of assigned tasks for internal and external stakeholders Candidate Profile: - Candidates with 7+ years of US healthcare claims experience - Experience in audit of workers compensation medical bills payment - Knowledge of CPT, Modifiers, ICD-10, DRG, Revenue codes and preauthorization guidelines - Comprehensive knowledge on health care industry, medical bills processing, AR and payment posting cycle - Thorough knowledge of payment rules hierarchy, fee schedule configuration and their impact on payment - Capability to provide inputs to technical team with potential cases of overpayment in Institutional and Professional medical bills - Preferred experience in data mining techniques using SAS/SQL/R or other similar language - Superior skills to effectively communicate and negotiate across the business and external health care environment - Demonstrate ability to interact effectively with non-technical clients and internal teams - Must be a dependable and reliable player, able to work independently and as part of a goal oriented team with a positive attitude - Must have strong analytical, reasoning, organizational and management skills

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