Claims Auditor

About the Role - Looking for Claims Auditor in Healthcare - Min 3 Years of experience. Responsibilities -

• Specifically in Claims adjudication, claims processing, pricing, administrative records review experience pertinent to US Healthcare PAYOR domain
• Medical Records Management, Clinical Audit based on Medical Records Review, Seasoned experience in US Healthcare (Payer/Provider LOB)
• Preferred to have worked over a period of time in US Healthcare payer/provider domain
• Understand the business model for our delivery center and then implement the same in the training vertical
• Should have effective communication skills to coordinate with program SMEs and candidates
• Should be well accustomed with reporting, presentations, creating training materials (videos/document) in granular level
• Should possess understanding of High Cost Drug and Durable Medical equipment auditing through Medical records review
• Previously working for US Healthcare Payer vertical/LOB will be an added advantage
• Follow every aspect of SOP without fail
• Complete received Audits with Quality
• To meet the team/Client Quality and 100% of production target on a daily basis
• Follow project related protocols and instructions
• Escalate issues, identify trends...
• Update all the logs like productivity, Clarification log, and any other logs applicable on a daily basis
• Should be read to extend support working on weekends a and when applicable
• Should be a good team member to ensure the smooth service delivery
• Should be a good and fast learner
• All emails from Leads, Team members, Manager and higher hierarchy should be answered promptly without fail
• Ensure Healthcare compliance of entire team for HIPAA, OIG, PHI etc.