About this role
Communication Skill:
Strong written (documentation) and oral communication skills
Working Hours:
Full-time role (40 hours/week).
Shift: 08:00 AM – 05:00 PM IST (subject to change based on project requirements).
Weekends: Off (may vary based on business needs).
Telecommuter/Internet requirements, if applicable:
High Speed internet connection at home must be broadband.
Must understand and adhere with telecommuter policy.
Skills and abilities:
• Should have a good understanding of the US healthcare system and management.
• Should have thorough understanding of healthcare payer analytics specifically the business model for datamining operations.
• Preferably candidates should have work experience in the data mining line of business.
• Should have thorough understanding contract audits, duplicates, reimbursement policies
• Will be responsible to audit claims on Medicare or Commercial business based various data mining concept.
• The position is purely metrics and target driven in the perspective of claim audits to initiate overpayment that exist in deployed data mining concepts.
• The position will be strictly evaluated based on the accuracy over claim audits and overpayments identification
• Should possess a strong interpersonal skill set to be able to work well with other people/teams, including in teams or groups, formally and informally.
• Should be able to work independently with minimal guidance.
• Should be purely data and metrics driven person and discuss with Manager on a regular basis on the program/individual.
Experience:
Claims Adjudication experience: Minimum 6 years
Overpayment experience.
Prefer candidates with experience in Post adjudication/overpayment projects.
Qualification:
Graduation is mandatory.