Job Description Position Title, Responsibility Level: Executive/Senior Executive

Function

Operations

Reports to -

Assistant Manager/Lead Assistant Manager

Permanent/ Temporary: Permanent Span of Control –

None

Location: C – 15, Noida

Basic Function This position is responsible for reviewing, analyzing and interpreting medical Information to assess and determine appropriate next action steps which may lead to denial or payment of claims.

Work is performed under general supervision according to established guidelines. This individual promotes capabilities from a customer perspective, aligning needs with the target offering by creating a customer self-service enabled platform for core customers.

Essential Functions- Responsible for reviewing and analyzing discrepancies by cross-verifying from different data sources

Familiar with US Healthcare domain knowledge and understanding of healthcare regulations (HIPAA)
Deep understanding of medical coding, billing, and medical terminologies
Attention for detail, and Strong analytical skills for processing medical documentation
Critical thinking and high independent decision making capability
Proficiency in healthcare information systems
Ability to navigate through multiple applications
Operates with urgency in a real time service environment
Meets individual goals while assisting team to meet team goals
Defines, communicates and manages workflow and data coordination to support various implementation related reports (i.e., reporting, inventory, capacity reporting, and ad-hoc reports as needed by management)
May perform other duties as assigned
Making outbound calls to agent, hospitals, pharmacy and doctors office to capture missing or required information

Performance parameters- Productivity

Quality
Turn Around Time of work assigned
Attendance & Schedule Adherence

Primary Internal Interactions

SME/AM/LAM/Manager for the purpose of reporting performance, escalation handling, clarifying concerns, and seeking support
AM/LAM for the purpose of settling issues left unresolved by the SME and monthly evaluation of performance
SME for the purpose of handling process related issues; queries and escalated transactions
QCA for the purpose of associate performance feedback and audit in order to update the training curriculum
Mentors for the purpose of seeking clarifications and answering queries real time

Organizational Relationships Reports To: Assistant Manager/Lead Assistant Manager Skills Desirable Skills- Critical thinking and high independent decision making

Strong analytical, Reasoning, and problem solving skills
Medium competency in excel skills
Ability to comprehend in English (written and verbal) for structured communication, including drafting effective emails and instant messages (IMs) for internal and external teams, as well as making professional calls to agent, hospitals, pharmacy and doctors office
Ability to respond to all inquiries within a timely manner
Strong interpersonal and communication skills – both verbal and written
Adaptability/Ability to interpret variable input details

Technical Skills- Good computer navigation skills

Typing speed of 25 Words per Minute with 90% Accuracy
Proficiency in healthcare information systems
Ability to navigate through multiple applications

Process Specific Skills- Familiar with US Healthcare domain knowledge and understanding of healthcare regulations (HIPAA)

Deep understanding of medical coding, billing, and medical terminologies
Ability to produce high quality in production in environment.
Ability to troubleshoot, identify user errors vs. system mapping errors (enrollment dates, method, system logic)

Soft skills- Ability to work independently

Ability to understand and question established process guidelines for possible process improvements
Attention for detail, and Strong analytical skills for processing medical documentation
Possess keen sense of acquiring knowledge
Adaptable and flexible to work in night shifts

Education Requirements and Work Experience:- Bachelor's degree in relevant field such as Biology, Biochemistry, Biotechnology, BPT, MPT, BDS etc

Computer literacy
Candidates with relevant business experience more than 1 year will be preferred

Annexure

Acknowledgement (acknowledge that the information contained in this document is factual and complete)

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Candidate Supervisor Date