-Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT/diagnosis codes , CMC guideline along with referring to client specific guidelines and member policies
-Adherence to state and federal compliance policies and contract compliance
-Assist the prospective team with special projects and reporting
-Medical degree - BPT/MPT Only
-Knowledge of US Healthcare and coding desirable
-Attention to detail & Quality focused.
-Good Analytical & comprehension skills
- Experience Range - 0 to 4 years ( Fresher's can apply)
-Health Insurance knowledge, managed care experience preferred
-Claims processing experience is helpful.
-Medical record familiarity is preferred