Skill required: Claims Appeals - Claims Administration

Designation: Health Admin Services Associate

Qualifications:Any Graduation

Years of Experience:1 to 3 years

About Accenture

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What would you do

Experience with Medicare Part C and Part D Appeals.
Knowledge of CMS regulations and turnaround requirements.
You will be a part of the Healthcare Claims team which is responsible for the administration of health claims This team is involved in core claim processing such as registering claims editing verification claims evaluation and examination litigation
Includes the administration of health, life, and property & causality claims.
Includes activities involved in core claim processing such as registering claims, editing & verification, claims evaluation, and examination & litigation. What are we looking for
Primary skill - Claims Administration - P1
Graduate degree.
2 to 4 years healthcare operations experience.
Experience in Medicare Appeals and Grievances processing. Roles and Responsibilities:
Handle end-to-end appeal processing.
Perform AOR validation and provider outreach.
Review denial rationale and supporting clinical documentation.
Prepare cases for Medical Director review.
Process determinations and effectuation activities
In this role you are required to solve routine problems, largely through precedent and referral to general guidelines.
Your expected interactions are within your own team and direct supervisor.
You will be provided detailed to moderate level of instruction on daily work tasks and detailed instruction on new assignments.
The decisions that you make would impact your own work.
You will be an individual contributor as a part of a team, with a predetermined, focused scope of work.
Please note that this role may require you to work in rotational shifts

Health Admin Services Associate - Voice