Job Description

• In-depth knowledge and experience in the US healthcare (Non Voice) - Provider Data Validation and Provider Data management.
• Ability to train the team on new process and process updates.
• Calibrate with QA's to ensure process knowledge and variance are managed and under control.
• Ability to create Process SOP, Process Map and identifying the outlier within process.
• Review Discrepancy report and comments, identify gaps and share with TL.
• Identify NVA and provide suggestion for automation opportunities.
• Leads teams to manage day to day inventory
• Monitors QA scores of production resources and performs reviews to improve overall performance
• Floor support to operations and 1st point of level of escalation to client in process, inventory, and performance metrics
• Identify refresher/re-trainable topics, conduct assessments, and certify staff to move to different levels of production.
• Drive team from the front in case of leadership unavailability.
• Need to co-ordinate with quality team to identify the root cause and provide appropriate solution to overcome errors.
• Ensures day-day transactions are processed per standard operating procedures.
• Follows Work process flow to ensure pends are completed and maintain Quality and timeliness standards.
• Knowledge in Amisys and Cenprov application are preferred.
• Product knowledge in checking affiliation for Medicaid, Medicare and Exchange.
• Everyday checked Contract information in Payment Index such as, Pay class, override key, accepts code and etc.
• Ability to read and understand the provider contract.
• Handling Paid claims and recouped claims.
• Claims Rejections handling.
• Working in claims denial management.
• Knowledge about End to End provider billing process.
• Working knowledge in EDI rejection claims
• Handing Patient and provider demographic changes.

Skills Required