Health Admin Services Associate

Skill required: Claims Appeals - Claims Administration

Designation: Health Admin Services Associate

Qualifications:Any Graduation

Years of Experience:1 to 3 years

About Accenture

Accenture is a global professional services company with leading capabilities in digital, cloud and security.Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song— all powered by the world's largest network of Advanced Technology and Intelligent Operations centers. Our 784,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We embrace the power of change to create value and shared success for our clients, people, shareholders, partners and communities.Visit us at www.accenture.com

What would you do

• 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
• Graduate degree.
• 2 to 4 years healthcare operations experience.
• Experience in Medicare Appeals and Grievances processing.
• Experience with Medicare Part C and Part D Appeals.
• Knowledge of CMS regulations and turnaround requirements. 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.