Job Description

Roles Responsibilities :

• Must have strong experience in CPT / ICD 10-CM Coding, Modifiers, Anatomy and Physiology, Sound surgery and E&M knowledge.
• Must possess good communication skill with neutral accent.
• Initiate telephone calls to provider office to communicate the outcome of the denial review.
• Willing to work in Eastern shift.
• Must be spontaneous and have high energy level.
• Minimum work experience in voice process will be an added advantage
• Manage claims with timely follow up.
• Must be good with MS Office, especially Excel and PPT.
• Understand the client requirements and specifications of the project.
• Ensure that the deliverable to the client and adhere to the quality standards.
• Mandatory CPC or CCS certification. "Should not have Apprentice in credential
• Handling of inbound / outbound calls from providers and hospitals to inquire about member account queries related to (Precert, Eligibility, benefits, and claims).
• Raise request for pending / denied claims inquiry form providers.
• Create request for onshore to email / fax / post the documents or payments.
• The applicant will be responsible for handling an array of front facing duties.
• Some of these tasks including interaction with customers over the phone, via email or chat.
• Should be able to determine eligibility by comparing client’s information against the requirements (particularly for claims).
• Should demonstrate the quality of attention to details, effective and clear communication, adaptability, empathy, patience and positive attitude.
• Ensure a secure and compliant work environment.

Skill Requirements :

Understanding of US Healthcare industry.