Multiple Openings in Data Processing, Customer Support, and Medical Management
We are seeking dedicated professionals to join our team in various roles related to data processing, customer support, and medical management. This is an excellent opportunity for individuals with a strong commitment to delivering high-quality service and maintaining accurate data management processes.
Position Overview
Roles Available:
- Data Processes
- Member Management
- Voice Processes
- Medical Management
- Claims
- RCM (Revenue Cycle Management)
- Provider Services
Qualifications
- General Requirement:
- Education: Graduate (excluding BE/BTech/MCA)
- For Medical Management:
- Bachelor’s degree in Nursing or any health science-related field
- For NA (Not Applicable):
- High School Equivalent
Key Responsibilities
Data Processes
- Transaction Processing:
- Efficiently process a predefined number of transactions with the highest level of accuracy as agreed upon with clients.
- Ensure the highest level of customer satisfaction.
- Resolve issues/queries on the first attempt.
- Maintain business controls and adhere to guidelines.
- Communicate effectively with clients/end-users.
- Member Management:
- Generate client-specified reports and respond to data requests.
- Release WCUM determinations to claim stakeholders following established protocols.
- Identify medical flags in the client system.
- Provide reports and data as specified by the client.
- Serve as the first level contact for customer complaint resolution.
- Project/Process:
- Ensure statistical, financial, and TAT metrics are met.
- Adhere to transaction processing timelines and audit compliance.
- Record production statistics and maintain confidentiality as per HIPAA protocols.
- Implement small process improvement projects and contribute innovative ideas.
Voice Processes
- Claims, RCM, Provider Services, and Member Services:
- Make and answer calls to/from customers/end-users within agreed time frames.
- Transfer calls to appropriate departments as per guidelines.
Medical Management
- Review Assessment:
- Identify cases eligible for medical reviews and assign them to appropriate reviewers.
- Reach out to clients for any issues identified in the cases.
- Adhere to URAC and other best practice UM time frames.
- Perform accurate and timely medical review assessments.
- Provide actionable insights based on medical records and manage assigned workload within performance standards.
Claims
- Claims Processing:
- Process claims documents with zero critical errors and complete transactions within specified TAT.
- Code complex plans and analyze benefit plans.
RCM
- Revenue Cycle Management:
- Follow up on pending claims and complete submissions, rejections, and payment postings as per SOPs.
- Complete coding transactions and highlight global issues.
Provider Services
- Provider Data Management:
- Handle complex transactions with stringent turnaround times.
- Update provider details and maintain database accuracy.
- Verify and validate provider information through approved sources.
Must-Have Skills
- Accounts Receivable
- Revenue Cycle Management
- Provider Calling
- Benefits Administration
Benefits
- Medical Insurance: Comprehensive medical insurance coverage.
Application Process
Interested candidates are encouraged to apply by submitting their resume to the provided email address. For more detailed information about the healthcare and medical management industries, you can explore the Medical Management and Revenue Cycle Management sections on Wikipedia.
Why Join Us?
Our company is dedicated to providing exceptional service and maintaining high standards in data processing and customer support. We offer a supportive work environment with opportunities for professional growth and development. If you are passionate about making a difference and excel in a dynamic work setting, we encourage you to apply and join our team.
Apply now and contribute to our mission of delivering high-quality service and data management solutions!
