Claim Adjudicator ( Trainee)

Role & responsibilities

Evaluates and processes claims in accordance with company policies and procedures per CMS guidelines/SOP

Reviews and analyzes data for in-process claims in order to identify and resolve errors prior to final adjudication

Exercises good judgment and remains knowledgeable in related company policies and procedures

Achieves teamwork, production and quality standards in order to assure timely, efficient and accurate claims processing

Extensive knowledge of Commercial, Medicaid, Medicare & TPA claims processing guidelines

Knowledge of medical coding/billing including ICD-10, CPT, CMS-1500, UB-04 etc.

Knowledge of different providers payment methodologies (i.e., capitation, fee for service based on RBRVS, Medicaid and other negotiated flat rates, RVS pricing, Per Diem, DRG pricing, etc.) preferred

Pay or deny per the guidelines/SOP

Maintain confidentiality of all information, policies, and procedures as required by the Health Insurance Portability and Accountability Act (HIPAA) protocols

Flexibility with shift according to client need is mandatory

He/She will report to Team Lead

Candidates with 6+ months experience is sought for Claim Analyst

Fresher with good analytical and communication can attempt for Trainee

Preferred candidate profile Fresher who can work in NIGHT SHIFTS ( US Shift timings ) Company transport not available

Perks and benefits ESI and PF benefits