HC & Insurance Operations Senior Assoc.

Job Title

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.