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Appeals Specialist - IB / Claims / MR Review and Auditing
ConfidentialHyderabad / Secunderabad, Telangana, India9 days ago
Job descriptionCertification in medical coding or auditing - CPMA (preferred), CPC, CCS, COC, etc. 3-4 years of experience in hospital billing, claims auditing, or insurance claims review. Knowledge of legal and regulatory aspects of healthcare reimbursement. Medical background with MBA / MHA preferrable, but not mandated
Summary : This position is responsible for reviewing, analyzing, and validating claims, itemized bills and medical records to ensure accuracy of charges, compliance with payer guidelines, and adherence to contractual agreements.
Responsibilities :
- Review itemized bills, claims, and supporting documentation for accuracy and completeness.
- Verify that billed services, procedures, and supplies are supported by medical records and documentation.
- Identify duplicate charges, unbundling, upcoding, non-covered services, or charges inconsistent with guidelines and billing protocol.
- Apply payer rules, federal / state regulations, and internal policies when evaluating charges.
- Compare charges against contracts, fee schedules, and usual & customary rates.
- Work on appeals related to billing discrepancies.
- Create documentation related to the above protocol.
Qualifications :
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Skills Required
Auditing, Medical Coding, claims auditing
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Specialist • Hyderabad / Secunderabad, Telangana, India