Job Summary
Manage and handle all Outbound calls and adjudicate claims.
Duties/Responsibilities:
- Adjudicating HP/AD claims
- Handling all Outbound calls
- Should be able to prioritize work and adjudicate claims as per turnaround time
- Job involves working independently on researching, reviewing, summarizing, and recommending a course of action on claims where an appeal or a grievance has been filed for a denied / under payment
- Should have strong English comprehension, mathematics & medical science knowledge to comprehend medical reports
- To ensure claims are adjudicated as per the client/company guidelines. Provide continual evaluation of processes and procedures.
- To respond to and resolves claims received via emails.
- Candidate should be able to correctly calculate claim amounts for the customers
- Complying with company regulations regarding HIPAA, confidentiality, and private health information
Standard Company Requirements:
- Collaborative team spirit.
- Accountable and able to work remotely and independently.
- Able to pass background screening and drug tests pre and post hire – includes THC
- Verification of high school, GED, or college diploma upon request.
- Timely responses from three professional references.
- Able to provide a dedicated remote work location free from background noises, interruptions, and desk clutter.
- Able to provide an ongoing reliable internet connection and access to a smart phone for Multi Factor Authentication and communication purposes.
Required Skills/Abilities:
- Should have knowledge of medical terminology, human anatomy with basic math knowledge of calculating simple interest, compound interest.
- Should have excellent problem-solving skills with an eye for detail, to be able to do root cause analysis of complex claims
- Should have a positive approach and open to learning process dynamics
- Ready to handle work pressure and ensure deliverables within timelines
Education and Experience:
- Experience in handling US HIP claims
- Should have knowledge of ICD 10, CPT, Surgery procedures, Revenue codes, medical terminology, medical documents, Inpatient vs Outpatient claims etc.
- Should have some experience in reading and comprehending medical documents