HC & INSURANCE OPERATIONS ANALYST

Position General Duties :

Associate will process and update Provider Data Management and Provider Data Enrollment Resources to the Client's main application according to its policies and procedures defined.

Role Responsibilities :

• In-depth knowledge and experience in the US healthcare (Non Voice) – Provider Data Validation and Provider Data management.
• Candidate should have 5 years and above experience in US healthcare and into provider enrollment and credentialling.
• 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.
• 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.
• Oversee data integrity of provider records and practitioner records that are loaded in the system.
• Provide research to correct errors in Provider and Practitioner data output within the provider information system.
• Maintain quality and production standards as outlined by government regulations and department policies & procedures.
• Completion of volumes in queue within specified Turn Around Time.
• Ability to meet their required production and Quality target.
• Setting productivity / Quality benchmark
• Handles internal and external inquiries concerning provider forms, demographics, location details and practitioner records.

Required Skills :

Skills Required

provider enrollment , data integrity, Ms Office