Ability to resolve claims that require adjustments and adjustment projects, Identify claim(s) with inaccurate data or claims that require review by appropriate team members.
Meet & Exceed Production, Productivity, and Quality goals
Process Insurance Claims timely and qualitatively
Review medical documents, policy documents, policy history, Claims history, and system notes and apply the trained client-level business rules to make appropriate Claims decisions, call out claims trends, and flag fraud activities.
*Having good exposure to CMS processing guidelines. *Good Analytical skills. *Good communication skills. *Working knowledge of MS office tools. *Willing to work in any shift.
Responsible for the coordination and resolution of the administrative denials and appeals.
Ability to understand logic of standard medical coding (i.e., CPT, ICD-10, HCPCS, etc.).
Ability to resolve claims that require adjustments and adjustment projects, Identify claim(s) with inaccurate data or claims that require review by appropriate team members.
Meet & Exceed Production, Productivity, and Quality goals
Process Insurance Claims timely and qualitatively
Review medical documents, policy documents, policy history, Claims history, and system notes and apply the trained client-level business rules to make appropriate Claims decisions, call out claims trends, and flag fraud activities