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0 years
0 Lacs
Chennai, Tamil Nadu, India
On-site
Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Focused on Revenue Cycle Management, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities. Come Join Our Team! As part of our robust Rewards & Recognition program, this role is eligible for our Ventra performance-based incentive plan, because we believe great work deserves great rewards. Help Us Grow Our Dream Team — Join Us, Refer a Friend, and Earn a Referral Bonus! Job Summary The Coding Denial Specialist responsibilities include working assigned claim edits and rejection work ques, Responsible for the timely investigation and resolution of health plan denials to determine appropriate action and provide resolution. Essential Functions And Tasks Processes accounts that meet coding denial management criteria which includes rejections, down codes, bundling issues, modifiers, level of service and other assigned ques. Resolve work queues according to the prescribed priority and/or per the direction of management in accordance with policies, procedures, and other job aides. Validate denial reasons and ensures coding is accurate. Generate an appeal based on the dispute reason and contract terms specific to the payor. This includes online reconsiderations. Follow specific payer guidelines for appeals submission. Escalate exhausted appeal efforts for resolution. Adhere to departmental production and quality standards. Complete special projects as assigned by management. Maintain working knowledge of workflow, systems, and tools used in the department. Education And Experience Requirements High school diploma or equivalent. One to three years’ experience in physician medical billing with emphasis on research and claim denials. Knowledge, Skills, And Abilities Knowledge of health insurance, including coding. Thorough knowledge of physician billing policies and procedures. Thorough knowledge of healthcare reimbursement guidelines. Knowledge of AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM and CPT coding. Computer literate, working knowledge of Excel helpful. Able to work in a fast-paced environment. Good organizational and analytical skills. Ability to work independently. Ability to communicate effectively and efficiently. Proficient computer skills, with the ability to learn applicable internal systems. Ability to work collaboratively with others toward the accomplishment of shared goals. Basic use of computer, telephone, internet, copier, fax, and scanner. Basic touch 10 key skills. Basic Math skills. Understand and comply with company policies and procedures. Strong oral, written, and interpersonal communication skills. Strong time management and organizational skills. Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills. Compensation Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons . This position is also eligible for a discretionary incentiv e bon us in accordance with company policies . Ventra Health Equal Employment Opportunity (Applicable only in the US) Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions. Recruitment Agencies Ventra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees related to unsolicited resumes. Solicitation of Payment Ventra Health does not solicit payment from our applicants and candidates for consideration or placement. Attention Candidates Please be aware that there have been reports of individuals falsely claiming to represent Ventra Health or one of our affiliated entities Ventra Health Private Limited and Ventra Health Global Services. These scammers may attempt to conduct fake interviews, solicit personal information, and, in some cases, have sent fraudulent offer letters. To protect yourself, verify any communication you receive by contacting us directly through our official channels. If you have any doubts, please contact us at Careers@VentraHealth.com to confirm the legitimacy of the offer and the person who contacted you. All legitimate roles are posted on https://ventrahealth.com/careers/. Statement of Accessibility Ventra Health is committed to making our digital experiences accessible to all users, regardless of ability or assistive technology preferences. We continually work to enhance the user experience through ongoing improvements and adherence to accessibility standards. Please review at https://ventrahealth.com/statement-of-accessibility/.
Posted 4 days ago
0 years
0 Lacs
Chennai, Tamil Nadu, India
On-site
Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Focused on Revenue Cycle Management, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities. Come Join Our Team! As part of our robust Rewards & Recognition program, this role is eligible for our Ventra performance-based incentive plan, because we believe great work deserves great rewards. Help Us Grow Our Dream Team — Join Us, Refer a Friend, and Earn a Referral Bonus! Job Summary The Coding Specialist is responsible for reviewing documents to identify all procedures and diagnosis. The Coding Specialist must ensure the encounters have been coded correctly based on documents received. The Coding Specialist must ensure encounters are coded using the most current coding guidelines. The Coding Specialist should be able to communicate and recognize inadequate or incorrect documentation so that all coding is completed compliantly. Essential Functions And Tasks Performs ongoing analysis of medical record documentation and codes assigned per CMS, CPT, and Ventra Health documentation guidelines. Assign appropriate ICD-10-CM and CPT codes and modifiers according to documentation. Perform MIPS review as needed. Perform Provider QA as needed. Document coding errors. Assist coding management. Assist with client/provider audits as needed. Assist with reviewing work product of new coders in training, as needed. Provides feedback to coders on coding discrepancies/deficiencies, as needed. Provides feedback to coding manager on documentation deficiencies in a timely manner. Respond to questions from designated coders. Maintain confidentiality for all personal, financial, and medical information found in medical records per HIPAA guidelines and Ventra Health policy. Education And Experience Requirements High School diploma or equivalent. RHIT and/or CPC required. At least one (1) year of medical billing preferred. 2023 MDM Guidelines required. Knowledge, Skills, And Abilities Understand the use and function of modifiers in CPT. In-depth knowledge of CPT/ICD-10 coding system. Ability to read and interpret documentation and assign appropriate codes for diagnosis and procedures. Ability to read, understand, and apply state/federal laws, regulations, and policies. Ability to remain flexible and work within collaborative and fast paced environment. Ability to communicate with diverse personalities in a tactful, mature, and professional manner. Knowledge of the requirements of medical record documentation. Knowledge of medical terminology and anatomy. Strong oral, written, and interpersonal communication skills. Strong time management and organizational skills. Basic use of computer, telephone, internet, copier, fax, and scanner. Basic knowledge of Outlook, Word, and Excel. Become proficient in the use of billing software within 4 weeks and maintain proficiency. Understand and comply with company policies and procedures. Compensation Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons . This position is also eligible for a discretionary incentiv e bon us in accordance with company policies . Ventra Health Equal Employment Opportunity (Applicable only in the US) Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions. Recruitment Agencies Ventra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees related to unsolicited resumes. Solicitation of Payment Ventra Health does not solicit payment from our applicants and candidates for consideration or placement. Attention Candidates Please be aware that there have been reports of individuals falsely claiming to represent Ventra Health or one of our affiliated entities Ventra Health Private Limited and Ventra Health Global Services. These scammers may attempt to conduct fake interviews, solicit personal information, and, in some cases, have sent fraudulent offer letters. To protect yourself, verify any communication you receive by contacting us directly through our official channels. If you have any doubts, please contact us at Careers@VentraHealth.com to confirm the legitimacy of the offer and the person who contacted you. All legitimate roles are posted on https://ventrahealth.com/careers/. Statement of Accessibility Ventra Health is committed to making our digital experiences accessible to all users, regardless of ability or assistive technology preferences. We continually work to enhance the user experience through ongoing improvements and adherence to accessibility standards. Please review at https://ventrahealth.com/statement-of-accessibility/.
Posted 4 days ago
0 years
0 Lacs
Chennai, Tamil Nadu, India
On-site
Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Focused on Revenue Cycle Management, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities. Come Join Our Team! As part of our robust Rewards & Recognition program, this role is eligible for our Ventra performance-based incentive plan, because we believe great work deserves great rewards. Help Us Grow Our Dream Team — Join Us, Refer a Friend, and Earn a Referral Bonus! Job Summary The Coding Specialist is responsible for reviewing documents to identify all procedures and diagnosis. The Coding Specialist must ensure the encounters have been coded correctly based on documents received. The Coding Specialist must ensure encounters are coded using the most current coding guidelines. The Coding Specialist should be able to communicate and recognize inadequate or incorrect documentation so that all coding is completed compliantly. Essential Functions And Tasks Performs ongoing analysis of medical record documentation and codes assigned per CMS, CPT, and Ventra Health documentation guidelines. Assign appropriate ICD-10-CM and CPT codes and modifiers according to documentation. Perform MIPS review as needed. Perform Provider QA as needed. Document coding errors. Assist coding management. Assist with client/provider audits as needed. Assist with reviewing work product of new coders in training, as needed. Provides feedback to coders on coding discrepancies/deficiencies, as needed. Provides feedback to coding manager on documentation deficiencies in a timely manner. Respond to questions from designated coders. Maintain confidentiality for all personal, financial, and medical information found in medical records per HIPAA guidelines and Ventra Health policy. Education And Experience Requirements High School diploma or equivalent. RHIT and/or CPC required. At least one (1) year of medical billing preferred. 2023 MDM Guidelines required. Knowledge, Skills, And Abilities Understand the use and function of modifiers in CPT. In-depth knowledge of CPT/ICD-10 coding system. Ability to read and interpret documentation and assign appropriate codes for diagnosis and procedures. Ability to read, understand, and apply state/federal laws, regulations, and policies. Ability to remain flexible and work within collaborative and fast paced environment. Ability to communicate with diverse personalities in a tactful, mature, and professional manner. Knowledge of the requirements of medical record documentation. Knowledge of medical terminology and anatomy. Strong oral, written, and interpersonal communication skills. Strong time management and organizational skills. Basic use of computer, telephone, internet, copier, fax, and scanner. Basic knowledge of Outlook, Word, and Excel. Become proficient in the use of billing software within 4 weeks and maintain proficiency. Understand and comply with company policies and procedures. Compensation Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons . This position is also eligible for a discretionary incentiv e bon us in accordance with company policies . Ventra Health Equal Employment Opportunity (Applicable only in the US) Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions. Recruitment Agencies Ventra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees related to unsolicited resumes. Solicitation of Payment Ventra Health does not solicit payment from our applicants and candidates for consideration or placement. Attention Candidates Please be aware that there have been reports of individuals falsely claiming to represent Ventra Health or one of our affiliated entities Ventra Health Private Limited and Ventra Health Global Services. These scammers may attempt to conduct fake interviews, solicit personal information, and, in some cases, have sent fraudulent offer letters. To protect yourself, verify any communication you receive by contacting us directly through our official channels. If you have any doubts, please contact us at Careers@VentraHealth.com to confirm the legitimacy of the offer and the person who contacted you. All legitimate roles are posted on https://ventrahealth.com/careers/. Statement of Accessibility Ventra Health is committed to making our digital experiences accessible to all users, regardless of ability or assistive technology preferences. We continually work to enhance the user experience through ongoing improvements and adherence to accessibility standards. Please review at https://ventrahealth.com/statement-of-accessibility/.
Posted 4 days ago
0 years
0 Lacs
Chennai, Tamil Nadu, India
On-site
Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Focused on Revenue Cycle Management, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities. Come Join Our Team! As part of our robust Rewards & Recognition program, this role is eligible for our Ventra performance-based incentive plan, because we believe great work deserves great rewards. Help Us Grow Our Dream Team — Join Us, Refer a Friend, and Earn a Referral Bonus! Job Summary The Coding Denial Specialist responsibilities include working assigned claim edits and rejection work ques, Responsible for the timely investigation and resolution of health plan denials to determine appropriate action and provide resolution. Essential Functions And Tasks Processes accounts that meet coding denial management criteria which includes rejections, down codes, bundling issues, modifiers, level of service and other assigned ques. Resolve work queues according to the prescribed priority and/or per the direction of management in accordance with policies, procedures, and other job aides. Validate denial reasons and ensures coding is accurate. Generate an appeal based on the dispute reason and contract terms specific to the payor. This includes online reconsiderations. Follow specific payer guidelines for appeals submission. Escalate exhausted appeal efforts for resolution. Adhere to departmental production and quality standards. Complete special projects as assigned by management. Maintain working knowledge of workflow, systems, and tools used in the department. Education And Experience Requirements High school diploma or equivalent. One to three years’ experience in physician medical billing with emphasis on research and claim denials. Knowledge, Skills, And Abilities Knowledge of health insurance, including coding. Thorough knowledge of physician billing policies and procedures. Thorough knowledge of healthcare reimbursement guidelines. Knowledge of AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM and CPT coding. Computer literate, working knowledge of Excel helpful. Able to work in a fast-paced environment. Good organizational and analytical skills. Ability to work independently. Ability to communicate effectively and efficiently. Proficient computer skills, with the ability to learn applicable internal systems. Ability to work collaboratively with others toward the accomplishment of shared goals. Basic use of computer, telephone, internet, copier, fax, and scanner. Basic touch 10 key skills. Basic Math skills. Understand and comply with company policies and procedures. Strong oral, written, and interpersonal communication skills. Strong time management and organizational skills. Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills. Compensation Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons . This position is also eligible for a discretionary incentiv e bon us in accordance with company policies . Ventra Health Equal Employment Opportunity (Applicable only in the US) Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions. Recruitment Agencies Ventra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees related to unsolicited resumes. Solicitation of Payment Ventra Health does not solicit payment from our applicants and candidates for consideration or placement. Attention Candidates Please be aware that there have been reports of individuals falsely claiming to represent Ventra Health or one of our affiliated entities Ventra Health Private Limited and Ventra Health Global Services. These scammers may attempt to conduct fake interviews, solicit personal information, and, in some cases, have sent fraudulent offer letters. To protect yourself, verify any communication you receive by contacting us directly through our official channels. If you have any doubts, please contact us at Careers@VentraHealth.com to confirm the legitimacy of the offer and the person who contacted you. All legitimate roles are posted on https://ventrahealth.com/careers/. Statement of Accessibility Ventra Health is committed to making our digital experiences accessible to all users, regardless of ability or assistive technology preferences. We continually work to enhance the user experience through ongoing improvements and adherence to accessibility standards. Please review at https://ventrahealth.com/statement-of-accessibility/.
Posted 4 days ago
2.0 years
0 Lacs
Bengaluru, Karnataka, India
On-site
Description The Central Programs Team, India (CPT India) team leads cross-functional projects that requires collaboration and partnership with Amazon businesses, geographical units and technical subject matter experts (SMEs). The projects are focused on initiatives to continually reduce risks and improve network WHS standards and procedures. Individuals gather business requirements, document functional and design specifications, identify appropriate resources needed, assemble the right project team, assign individual responsibilities and develop the milestones and launch schedules to ensure timely and successful delivery of the project. The team members measure and report progress, anticipate and resolve bottlenecks, provide escalation management, anticipate and make tradeoffs, and balance the business needs with the technical constraints. This a program management role responsible for executing per direction, the management of the WW WHS programs (standards, procedures, best practices) development, training and continuous improvement projects. The role involves hands-on work in the areas of understanding stakeholder needs and expectations, WHS regulatory research, global stakeholder engagement, data analytics and document technical writing. The candidate must be a self-starter and detail-oriented. They must be an effective communicator and send clear, concise and consistent messages, both verbally and in writing. Key job responsibilities Program/Process Improvement, Project Management Clearly and timely communicate findings, determinations, and recommendations to compliance management and business partners, both at periodic intervals and as needed regarding escalated or high-risk compliance issues. Guide management in the development/review of applicable policies, procedures and business practices. Engage in frequent written and verbal communication with management and business partners to accomplish goals. Execute and drive audits to completion per SOP. This includes drafting audit reports, stakeholder reviews of audit reports, finalizing and tracking audit reports in database and tracking issues in system (and SIM/TT management). Owns weekly/monthly reports and metrics. Identifies gaps in audit programs and processes and escalates to manager. Follows confidentiality rules with the documents reviewed. Drafts documents and revisions on audit reports per manager direction. Performs deep dive analysis/research on data/information/literature and creates recommendations/corrective actions based on identified deviations and recommends appropriate solutions. Earns trust of peers by understanding audit processes and programs. Makes recommendations to managers for input into roadmap strategic discussions and continuous improvement projects to drive program efficiencies. Basic Qualifications Bachelor’s degree or higher and a minimum of 2 years relevant program management experience. Strong project management skills. Excellent computer skills for use of digital tools for project management, document control and data visualization (Advanced MS Excel, Sharepoint, Visio,Quicksight). Strong verbal and written communication skills. Strong technical aptitude in understanding data and reporting insights. Competent business and technical writing skills. Ability to navigate in ambiguous situations and work in a fast-paced, ambiguous and rapidly evolving environment. Strong attention to detail and organizational skills. Ability to prioritize in complex, fast-paced environment with multiple competing priorities. Preferred Qualifications PMP certification Experience with Lean, Six Sigma analytical techniques (green or yellow belt) Advanced Excel (Macros/VBA) Experience with Stakeholder Management across Geographies Program/Project Management Certification -Six Sigma Certification Knowledge of SQL/ Python Knowledge of visualization tools like QuickSight, Tableau etc. Our inclusive culture empowers Amazonians to deliver the best results for our customers. If you have a disability and need a workplace accommodation or adjustment during the application and hiring process, including support for the interview or onboarding process, please visit https://amazon.jobs/content/en/how-we-hire/accommodations for more information. If the country/region you’re applying in isn’t listed, please contact your Recruiting Partner. Company - ADCI - Karnataka Job ID: A3001436
Posted 4 days ago
7.0 years
5 - 7 Lacs
Hyderābād
On-site
Job Title: Senior Clinical Data Scientist / Clinical Data Analyst Experience: 7+ Years Location: Bangalore / Chennai / Hyderabad / Noida / Gurgaon (India) Industry: Pharmaceutical / Healthcare / Life Sciences Employment Type: Full-time Job Summary: We are seeking a highly experienced and analytical Senior Clinical Data Scientist / Analyst with 7+ years of experience in clinical data analysis, pharmaceutical research, and data science methodologies . The ideal candidate will have hands-on experience working with EMR/EHR data , advanced SQL , and machine learning models to derive actionable insights that support clinical research and drug development. Key Responsibilities: Analyze and interpret complex clinical and EMR data to support real-world evidence (RWE), HEOR, and clinical trial analysis. Design and develop statistical and machine learning models to predict patient outcomes, drug efficacy, and safety. Perform deep-dive analytics using Advanced SQL (CTE, RANK, PARTITION) for cohort identification and data transformation. Collaborate with cross-functional teams including biostatisticians, clinical operations, and regulatory affairs. Ensure data quality and integrity from diverse sources like EMR, claims, lab systems, and clinical trial management systems (CTMS). Automate data pipelines and implement best practices in reproducible analytics. Create dashboards, data visualizations, and reports for stakeholders and medical affairs teams. Stay up to date with current industry trends in real-world data (RWD), clinical informatics, and regulatory requirements. Required Skills: 7+ years of experience in clinical data analytics or data science within the Pharma/Healthcare domain . Strong expertise in Advanced SQL : CTEs, Window Functions (RANK, DENSE_RANK, PARTITION BY), joins, subqueries. Experience working with EMR/EHR systems such as Epic, Cerner, Meditech, etc. Proficiency in Python, R , or SAS for statistical and machine learning modeling. Strong knowledge of clinical trial design , ICD/CPT coding , MedDRA , and pharmacovigilance datasets. Hands-on with machine learning frameworks (Scikit-learn, XGBoost, etc.) for prediction and classification tasks. Familiarity with regulatory guidelines such as HIPAA , GCP , and 21 CFR Part 11 . Experience with data visualization tools such as Tableau, Power BI, or Python-based dashboards . Preferred Qualifications: Master’s or Ph.D. in Data Science, Biostatistics, Bioinformatics, Public Health, or a related field . Prior experience in RWE/RWD analytics , HEOR studies , or pharma R&D analytics . Knowledge of CDISC SDTM/ADaM standards . Experience working with cloud platforms (AWS, Azure, GCP) and data lake architecture is a plus. Job Type: Contractual / Temporary Contract length: 12 months Schedule: US shift Application Question(s): What would your NP? Which location would you pick Bangalore / Chennai / Hyderabad / Noida / Gurgaon (India) Experience: Data science: 5 years (Preferred) Machine learning: 5 years (Preferred) EMR systems: 5 years (Preferred) Work Location: In person
Posted 4 days ago
2.0 years
2 - 9 Lacs
Hyderābād
On-site
Hyderabad Job Role: Reviewing and analyzing claim form 1500 to ensure accurate billing information. Utilizing coding tools like CCI and McKesson to validate and optimize medical codes. Familiarity with payer websites to verify claim status, eligibility, and coverage details. Expertise in various medical specialties such as cardiology, radiology, gastroenterology, pediatrics, emergency medicine, and surgery. Proficiency in using CPT range and modifiers for precise coding and billing. Working with Clearing House systems like Waystar and other e-commerce platforms for claim submissions. Conducting voice-based communication with payers and medical staff to resolve billing discrepancies and facilitate claims processing. Desired Candidate Profile: Should be a complete Graduate. Comfortable signing a Retention Period. Minimum of 2 years of experience in physician revenue cycle management and AR calling. Basic knowledge of claim form 1500 and other healthcare billing forms. Proficiency in medical coding tools such as CCI and McKesson. Familiarity with payer websites and their processes. Expertise in specialties including cardiology, radiology, gastroenterology, pediatrics, orthopedics, emergency medicine, and surgery. Understanding of Clearing House systems like Waystar and e-commerce platforms. Excellent communication skills. Comfortable working in Night Shifts. Ready to join immediately or within a 15-day notice period. Timings & Transport: Candidates need to be within a radius of 25 km from Sutherland, Manikonda Lanco Hills. Two-way cab facility will be provided within the radius of 25 km from Sutherland, Manikonda Lanco Hills, with shifts from 6:30 PM to 3:30 AM IST. Complete night shifts (6:30 PM – 3:30 AM IST). Five days working (Monday – Friday) with Saturday and Sunday off. Need to be comfortable with Work From Office (WFO). Perks and Benefits: Provides Night Shift Allowance. Saturday and Sunday fixed week offs. 24 days of leave in a year with up to Rs. 5000 incentives. Self-transportation bonus up to Rs. 3500.
Posted 4 days ago
0 years
0 Lacs
Chennai, Tamil Nadu, India
On-site
CT HR Padma - 8608995522 (Whats App) Position: Medical Coder Job Description: Medical Coding is the process of conversion of text information related to healthcare services into numeric Diagnosis (Medical Problems) and Procedure (Treatments) Codes using ICD-10 CM and CPT code books. Requirement: Knowledge in Anatomy and Physiology Good communication and interpersonal skills Basic Computer Skills No of vacancy: 500 Eligibility: Nursing GNM/DGNM Life science graduates Pharmacy Physician assistant Bio medical Engineers Bio chemistry Bio technology Micro biology Zoology and Advanced zoology Biology Plant biotechnology Paramedical Physiotherapy M.Sc. Clinical Nutrition M.Sc. Medical Laboratory Technology M.Sc. Medical Sociology M.Sc. Epidemiology M.Sc. Molecular Virology M.Sc. Radiology & Imaging Technology M.Sc. Medical Biochemistry M.Sc. Medical Microbiology M.Sc. Clinical Care Technology B.Sc. - Accident & Emergency Care Technology B.Sc. - Audiology & speech Language Pathology B.Sc. - Cardiac Technology B.Sc. - Cardio Pulmonary Perfusion Care Technology B.Sc. - Critical Care Technology B.Sc. - Dialysis Technology B.Sc. - M.L.T. B.Sc. - Medical Sociology B.Sc. - Nuclear Medicine Technology B.Sc. - Operation Theatre &Anesthesia Technology Bachelor of Science in Optometry B.Sc. - Physician Assistant B.Sc. - Radiology Imaging Technology B.Sc. - Radiotherapy Technology B.Sc. - Respiratory Therapy Accident & Emergency Care Technology Critical Care Technology Operation Theatre & Anesthesia Technology Ophthalmic Nursing Assistant Medical Record Science Optometry Technology Radiology & Imaging Technology Medical Lab Technology Dialysis Technology Dentist Salary 14K to 18K (fresher) To 50K (experienced) Pm (Incentives & Benefits as per Corporate Standards) 5k Incentives Based on performance Other Benefit: 1. Pick Up & Drop Facility 2. Food Facility 3. Day Shift 4. Weekend Off Reach us : PADMA HR - 8608995522 jobs@iskillssolutions.com
Posted 4 days ago
2.0 years
0 Lacs
Tiruchirappalli, Tamil Nadu, India
On-site
We are looking for US IT Recruiter. Location: Trichy, Tamil Nadu. Experience: 2+ yrs. Salary: Industry Standard Benefits: Health Benefit: Medical Insurance (For Family which includes Covid -19) Recurring highest incentives Onsite opportunities Overseas Trips for top performers Annual & Half yearly appraisal for performers Rewards & Recognition - Weekly & Monthly, Quarterly Job Description: Minimum 2+years of experience in US IT Recruitment Experience working with OPT, CPT, H1B s, TN s, GC s, USC s & EAD s Ability to interact, develop tier-1 Vendor network and get the H1B/OPT/CPT candidates placed in minimal turnaround time. Experienced with End to End cycle of sales from submitting Profiles, Rate Negotiations and Follow Up. Knowledge of Employment Type w2, Corp to Corp, 1099. Negotiate rates with the Vendors/ Clients. Taking care of the Consultants whether they are comfortable with the work environment. Speak to the Vendors regarding the performance of the consultant and the queries that the consultant brings to my notice. Maintaining Good interpersonal relation with the Client and the Vendors. Identifying potential Vendors and maintaining a healthy relation with them Inbox your profile to sathees@lorventech.com / 97156 27307
Posted 4 days ago
1.0 years
0 Lacs
Pune, Maharashtra, India
On-site
Job Title: Medical Billing Executive Location: On-site, Pune, India (U.S. Night Shift – EST) Reporting To: U.S.-Based Finance & Billing Team About Berwick Hospital Center: Berwick Hospital Center, located in Pennsylvania, USA, is a trusted behavioral health facility that provides compassionate, patient-centered care to adults and geriatric patients. The hospital specializes in mental health services, including inpatient psychiatric care for conditions such as depression, anxiety, bipolar disorder, and other psychiatric illnesses. With a focus on quality, compliance, and clinical excellence, Berwick Hospital Center is committed to supporting the well-being of its community through evidence-based treatment and personalized care. Job Overview: As an Medical Billing Executive , you will play a vital role in supporting Berwick Hospital Center’s financial operations by managing both Accounts Payable (AP) and Accounts Receivable (AR) processes. This dual-function role requires experience in U.S. healthcare billing, proficiency in QuickBooks and medical billing software, and strong knowledge of insurance claim cycles and U.S. healthcare compliance standards. You will be responsible for invoice processing, vendor payments, insurance follow-up, denial management, and payment posting while working closely with U.S.-based billing and finance teams. Key Responsibilities: Accounts Payable (AP): Process vendor invoices related to medical services and supplies Match invoices to purchase orders and medical service records Monitor and reconcile payments, flag discrepancies, and escalate unresolved issues Maintain accurate AP and billing records in compliance with U.S. healthcare regulations Support finance team in month-end closing, audits, and reporting Use QuickBooks to manage AP workflows Accounts Receivable (AR): Follow up with insurance companies (via phone or portal) on outstanding claims Identify, analyze, and resolve claim denials, rejections, and underpayments Accurately post payments and reconcile patient and insurance balances Coordinate with coding and charge entry teams to resolve billing issues Ensure claims meet payer-specific and HIPAA compliance requirements Manage AR aging reports and escalate problematic claims for resolution Utilize Medsphere and SSI Payment Clearinghouse for claim submissions and tracking Maintain updated documentation of patient accounts and billing interactions Assist with month-end closing and performance metrics Job Requirements: Minimum 1 year of experience in AP or AR roles within U.S. healthcare billing Proficiency in QuickBooks and familiarity with U.S. billing software (e.g., Medsphere, eClinicalWorks, SSI) Strong knowledge of CPT coding, claim cycles, EOBs, and healthcare billing workflows Understanding of Medicare, Medicaid, and commercial insurance policies Excellent verbal and written communication skills High attention to detail with strong documentation and follow-up skills Ability to work in a deadline-driven and compliance-focused environment Willingness to work night shifts (Eastern Standard Time – EST) Bachelor’s degree in Commerce, Accounting, or Healthcare Administration preferred
Posted 4 days ago
1.0 years
0 Lacs
Chennai, Tamil Nadu, India
On-site
Job Title: Radiology Medical Coder Years of Experience: 1 year No of openings: 15 Notice period: Immediate to 15days Job Summary: We are seeking detail-oriented and experienced Radiology Medical Coders . The ideal candidate will accurately assign CPT, ICD-10-CM, Modifiers and HCPCS codes for diagnostic and Therapeutic radiology procedures, ensuring compliance with federal regulations, payer-specific requirements, and internal quality standards. Key Responsibilities: Review and analyze radiology reports to assign accurate diagnosis and procedure codes. Ensure coding compliance in accordance with ACR, CMS, and payer guidelines. Code a variety of radiology modalities including X-ray, CT, MRI, Ultrasound, Nuclear Medicine, and Radiation oncology. Collaborate with radiologists, billing staff, and auditors to resolve coding discrepancies. Stay updated with coding guidelines, NCCI edits, and regulatory changes. Meet daily productivity and accuracy benchmarks as established by the department. Assist in internal and external audits as needed. Qualifications: Certified Professional Coder (CPC) Minimum of [1- 2] years of hands-on experience in radiology coding (IR preferred). MIPS Coding is Mandatory. In-depth knowledge of CPT®, ICD-10-CM, and HCPCS Level II codes Familiarity with payer-specific rules and LCD/NCD policies.
Posted 5 days ago
3.0 years
0 Lacs
Chennai, Tamil Nadu, India
On-site
Job Title: Interventional Radiology Medical Coder Years of Experience: 3 years Job Summary: We are seeking detail-oriented and experienced Interventional Radiology Medical Coders . The ideal candidate will accurately assign CPT, ICD-10-CM, Modifiers and HCPCS codes for diagnostic and Therapeutic interventional radiology procedures, ensuring compliance with federal regulations, payer-specific requirements, and internal quality standards. Key Responsibilities: Review and interpret complex interventional radiology reports to assign accurate codes for procedures and diagnoses. Apply appropriate CPT®, ICD-10-CM, and HCPCS codes for vascular and non-vascular IR procedures Ensure compliance with ACR, CMS, NCCI, payer-specific rules, and LCD/NCD policies. Keep up to date with IR coding guidelines, CPT® changes, and compliance regulations. Support internal and external audits by providing detailed coding rationale and documentation. Qualifications: Certified Professional Coder (CPC) or CIRCC certification strongly preferred Minimum of 3 years of hands-on experience in Interventional radiology coding. MIPS Coding is Mandatory. Familiarity with radiology workflow, RIS/PACS systems, and coding tools. In-depth knowledge of CPT®, ICD-10-CM, and HCPCS Level II codes
Posted 5 days ago
3.0 years
0 Lacs
Bengaluru, Karnataka
On-site
- Bachelor’s degree in Science / Engineering or equivalent from an accredited university - Minimum 3 years relevant program management experience - Analytical skills with experience using Excel (analysis using aggregate functions and pivot table) - Good communication skills both verbal and writing (Ability to communicate clear and coherent narratives) The Central Programs Team, India (CPT India) team leads cross-functional projects that requires collaboration and partnership with Amazon businesses, geographical units and technical subject matter experts (SMEs). The projects are focused on initiatives to continually reduce risks and improve network WHS standards and procedures. Individuals gather business requirements, document functional and design specifications, identify appropriate resources needed, assemble the right project team, assign individual responsibilities and develop the milestones and launch schedules to ensure timely and successful delivery of the project. The team members measure and report progress, anticipate and resolve bottlenecks, provide escalation management, anticipate and make tradeoffs, and balance the business needs with the technical constraints. This a program management role responsible for executing per direction, the management of the WW WHS programs (standards, procedures, best practices) development, training and continuous improvement projects. The role involves hands-on work in the areas of understanding stakeholder needs and expectations, WHS regulatory research, global stakeholder engagement, data analytics and document technical writing. The candidate must be a self-starter and detail-oriented. They must be an effective communicator and send clear, concise and consistent messages, both verbally and in writing. Key job responsibilities • Program/Process Improvement, Project Management • Clearly and timely communicate findings, determinations, and recommendations to compliance management and business partners, both at periodic intervals and as needed regarding escalated or high-risk compliance issues. • Guide management in the development/review of applicable policies, procedures and business practices. Engage in frequent written and verbal communication with management and business partners to accomplish goals. • Execute and drive audits to completion per SOP. This includes drafting audit reports, stakeholder reviews of audit reports, finalizing and tracking audit reports in database and tracking issues in system (and SIM/TT management). • Owns weekly/monthly reports and metrics. • Identifies gaps in audit programs and processes and escalates to manager. • Follows confidentiality rules with the documents reviewed. • Drafts documents and revisions on audit reports per manager direction. • Performs deep dive analysis/research on data/information/literature and creates recommendations/corrective actions based on identified deviations and recommends appropriate solutions. • Earns trust of peers by understanding audit processes and programs. • Makes recommendations to managers for input into roadmap strategic discussions and continuous improvement projects to drive program efficiencies. Advanced Excel (Macros/VBA) Experience with Stakeholder Management across Geographies - Program/Project Management Certification -Six Sigma Certification Knowledge of visualization tools like QuickSight, Tableau Our inclusive culture empowers Amazonians to deliver the best results for our customers. If you have a disability and need a workplace accommodation or adjustment during the application and hiring process, including support for the interview or onboarding process, please visit https://amazon.jobs/content/en/how-we-hire/accommodations for more information. If the country/region you’re applying in isn’t listed, please contact your Recruiting Partner.
Posted 5 days ago
1.0 years
0 Lacs
Andhra Pradesh, India
On-site
At PwC, our people in operations consulting specialise in providing consulting services on optimising operational efficiency and effectiveness. These individuals analyse client needs, develop operational strategies, and offer guidance and support to help clients streamline processes, improve productivity, and drive business performance. In operations and solutions at PwC, you will focus on providing consulting services to optimise overall operational performance and develop innovative solutions. You will work closely with clients to analyse operational processes, identify areas for improvement, and develop strategies to enhance productivity, quality, and efficiency. Working in this area, you will provide guidance on implementing technology solutions, process automation, and operational excellence frameworks. You are a reliable, contributing member of a team. In our fast-paced environment, you are expected to adapt, take ownership and consistently deliver quality work that drives value for our clients and success as a team. Skills Examples of the skills, knowledge, and experiences you need to lead and deliver value at this level include but are not limited to: Apply a learning mindset and take ownership for your own development. Appreciate diverse perspectives, needs, and feelings of others. Adopt habits to sustain high performance and develop your potential. Actively listen, ask questions to check understanding, and clearly express ideas. Seek, reflect, act on, and give feedback. Gather information from a range of sources to analyse facts and discern patterns. Commit to understanding how the business works and building commercial awareness. Learn and apply professional and technical standards (e.g. refer to specific PwC tax and audit guidance), uphold the Firm's code of conduct and independence requirements. Job Summary - A career in our Managed Services team will give you an opportunity to collaborate with many teams to help our clients implement and operate new capabilities, achieve operational efficiencies, and harness the power of technology. Our Revenue Cycle Managed Services team will provide you with the opportunity to act as an extension of our healthcare clients' revenue cycle functions. We specialize in front, middle and back-office revenue cycle functions for hospitals, medical groups, and other providers. We leverage our custom and automated workflow and quality assurance products to enable our clients to achieve better results, which ultimately allows them to provide better patient care. Minimum Degree Required (BQ) *: Bachelor’s Degree Degree Preferred Bachelor’s Degree Required Field(s) Of Study (BQ) Computer Science, Data Analytics, Accounting Preferred Field(s) Of Study Minimum Year(s) of Experience (BQ) *: US 1 year of experience Certification(s) Preferred Required Knowledge/Skills (BQ): Preferred Knowledge/Skills *: Job Description Summary Insurance Follow-Up: Contact insurance companies via phone, email, or online portals to follow up on outstanding claims. Identify and resolve issues causing payment delays, such as claim denials or underpayments. Verify claim status, appeal denied claims, and resubmit claims when necessary. Documentation and Reporting: Maintain accurate and detailed documentation of all communications and actions taken. Update account information and billing systems with payment details and follow-up notes. Generate reports on accounts receivable status, aging trends, and collection efforts. Compliance and Regulations: Adhere to HIPAA regulations and guidelines to ensure patient confidentiality and data security. Stay informed about insurance policies, billing guidelines, and industry changes affecting reimbursement. Team Collaboration: Collaborate with internal departments, including billing, coding, and collections teams, to resolve payment issues. Participate in meetings and discussions to improve revenue cycle processes and workflow. PMS Experience: Epic HB or PB experience is Mandatory Requirements Proven experience (1-2 years) in healthcare revenue cycle management, specifically in accounts receivable follow-up and collections. Strong understanding of medical billing processes, insurance claims, and reimbursement methodologies. Excellent communication skills with the ability to effectively interact with insurance companies, patients, and internal stakeholders. Proficiency in using billing software, electronic health records (EHR), and Microsoft Office applications. Attention to detail and ability to prioritize tasks to meet deadlines. Knowledge of medical coding (ICD-10, CPT) is a plus. Experience Level: 1 to 2 years. Shift timings: Flexible to work in night shifts (US Time zone) Preferred Qualification: Bachelor’s degree in finance or Any Graduate
Posted 5 days ago
1.0 - 5.0 years
0 Lacs
ahmedabad, gujarat
On-site
As a Medical Billing Specialist, your primary responsibility will be to efficiently manage the end-to-end Account Receivable (AR) processes in medical billing. You will be required to follow up on claim approvals, denials, and appeals diligently to ensure timely reimbursements. Generating and analyzing AR reports will be crucial for tracking collection performance. In addition, you will need to communicate effectively with insurance companies and patients to address billing inquiries in a prompt manner. It is essential to reconcile accounts, process refunds, and resolve any billing discrepancies that may arise. Your expertise in CPT, ICD-10, and HCPCS coding is vital for this role. To excel in this position, you should possess 1-3 years of experience in medical billing and AR management. A strong understanding of healthcare insurance claims and billing processes is essential. Excellent communication and negotiation skills are a must, along with proficiency in billing software and MS Office. Previous experience in Revenue Cycle Management, specifically in Physician Billing, will be advantageous. Your ability to analyze insurance remittance advice, clearinghouse rejections, and denials will be critical for success. This is a full-time position that involves working night shifts from 5:30 PM to 2:30 AM at the office. The role offers benefits such as a flexible schedule, provided meals, leave encashment, paid sick time, and paid time off. Prior work experience of at least 1 year is preferred for this role. The job requires in-person work at the specified location. In summary, as a Medical Billing Specialist, you will play a pivotal role in ensuring efficient AR processes, timely reimbursements, and effective communication with stakeholders to optimize billing operations.,
Posted 5 days ago
0 years
0 Lacs
Tiruchirappalli, Tamil Nadu, India
On-site
Hiring for Recruiters We are looking for Sr US IT Recruiter Location : Trichy, Tamil Nadu. Experience : 2Plus Yrs . Salary : Industry Standard. Key Responsibilities: • Recruit candidates with H1B, OPT, CPT, TN, GC, USC, and EAD visas. • Manage relationships with vendors and clients. • Handle the recruitment process from start to finish. • Understand W2, Corp-to-Corp, and 1099 employment types. • Negotiate rates and support consultants. Inbox your profile to gopi@lorventech.com
Posted 5 days ago
1.0 - 31.0 years
2 - 4 Lacs
Chennai
On-site
Job Title: Medical Coder Location: Bengaluru, Chennai, Hyderabad, Pune, Trichy, Salem Job Description: We are seeking a detail-oriented Medical Coder to review and accurately code medical records using ICD-10, CPT, and HCPCS codes. Responsibilities include ensuring compliance with regulations, supporting billing accuracy, and working closely with healthcare professionals. Key Responsibilities: Assign appropriate codes for diagnoses and procedures Ensure coding accuracy and regulatory compliance Review clinical documents for completeness Collaborate with billing and healthcare teams Requirements: Speciality - Radiology (Certification required), Surgery, IPDRG To Apply: Asthha - 6367203420/ asthha@jobsflix.in
Posted 5 days ago
10.0 - 14.0 years
0 Lacs
thane, maharashtra
On-site
You have at least 10 years of experience in the Medical Coding business, specifically in Inpatient coding, Medical Coding guidelines, and Coding Techniques (ICD-10, CPT). You possess strong knowledge of Anatomy & Physiology, Advanced Medical Terminology, Psychology, and Pharmacology. Proficiency in using MS Office is essential, along with excellent communication and interpersonal skills. As a Senior Manager Quality in the Home Health department of Business Excellence Coding, located in Airoli, Navi Mumbai, your responsibilities include: - Supervising and managing a team of 100+ Quality Analysts - Creating an inspiring team environment with open communication - Designing QA capacity planning according to project requirements - Delegating tasks, setting deadlines, and ensuring quality control based on client SLAs - Implementing the organization's Quality Management System effectively - Monitoring team performance, reporting on metrics, and conducting random audits - Performing Root Cause Analysis on audit observations, identifying knowledge gaps, and developing action plans with quality leads and operation managers - Identifying training needs, providing coaching to QAs, and resolving any team member issues or conflicts - Recognizing high performance, rewarding accomplishments, and encouraging creativity and business improvement ideas - Suggesting and organizing team-building activities and initiating action plans for improvement opportunities The ideal candidate for this role must have: - Over 10 years of experience in Medical Coding within Home Health, either in Operations or Quality teams - Leadership experience managing medium to large-sized teams for training & Quality teams, preferably across multiple sites - Certification such as CPC/CIC/COC/CSS If you meet these requirements and are ready to take on a challenging role that involves leading a team towards quality excellence in Medical Coding, we encourage you to apply for the position of Senior Manager Quality at our Airoli, Navi Mumbai office.,
Posted 5 days ago
5.0 years
0 Lacs
Mohali district, India
On-site
About the Role: We are seeking a sharp, detail-oriented Quality Analyst with proven experience in U.S. Healthcare Revenue Cycle Management (RCM) to join our growing team. This role is critical in ensuring accuracy, compliance, and process excellence across the entire RCM lifecycle—from End-to-End. If you have a passion for quality, a strong understanding of billing workflows, and a keen eye for detail, we'd love to hear from you. Key Responsibilities: Conduct quality audits for RCM functions, including Eligibility, Authorization, Charge Entry, Claims Submission, Payment Posting, Denial Management, and AR Follow-up Analyze test requirements and perform functional, regression, and end-to-end testing on healthcare billing applications Validate HIPAA-compliant claim files, payer rules, CPT/ICD code mapping, and insurance-specific workflows Perform backend data validation using SQL to ensure data integrity across billing and financial records Identify errors, audit trends, and training needs to improve team performance and billing accuracy Generating comprehensive reports on quality performance and sharing feedback with team members on a weekly or monthly basis. Collaborate with cross-functional teams, including operations, training, developers, and business analysts, to support process enhancements Track and report key quality metrics, driving continuous improvement initiatives Ensure compliance with HIPAA, CMS, and U.S. healthcare payer regulations Support UAT and production validations for new releases and billing system updates Lean Six Sigma (Green Belt / Black Belt): For reducing errors, improving workflows, and driving operational efficiency. Certified Quality Auditor (CQA) – ASQ: For professionals conducting audits of quality systems and processes. Project Management Professional (PMP): For managing cross-functional QA and system improvement projects. Certified Health Data Analyst (CHDA) – AHIMA: For analyzing healthcare data to improve billing and QA outcomes. SQL/Data Analytics Certifications (Microsoft, Oracle, Coursera): For backend validation and reporting. Required Qualifications: 1–5 years of hands-on QA or auditing experience in U.S. Healthcare RCM and medical billing In-depth knowledge of end-to-end RCM workflows : Eligibility, Authorization, Coding, Claims, Denials, and AR Solid understanding of HIPAA and healthcare data privacy standards Excellent attention to detail, communication, and analytical skills Experience with billing or practice management platforms (e.g., Kareo , AdvancedMD , eClinicalWorks , Athena , Epic , or Cerner ) and also in payor portals Why Join Us: Opportunity to work with a dynamic team of professionals and achieve growth and expertise in your chosen field. Competitive salary, bonuses, and comprehensive benefits package. Ready to take your design and development game to the next level? Join us!
Posted 5 days ago
0.0 years
0 Lacs
Bengaluru, Karnataka
On-site
Please Note: English language proficiency is required for this role. This is a full-time , work from office role. This requires a U.S. schedule - India Night shift. Work Location: This is a Work from Office position and location is Bangalore at: Block 12B, Pritech Park,3rd Floor, SEZ Survey No 51-64/4, Bellandur,Village. Bldg 9A Rd, Bengaluru –Karnataka 560103 Shift: Night Contact: Nirmala 911 301 5045 Build Your Future! Come join our thriving team as a Claims Resolution Specialist! We are seeking ambitious, self-motivated and driven people just like you for a rewarding career in the RCM Healthcare arena. Why should you consider TSI (part of TSI family of companies)? Paid training Team-oriented work environment Growth opportunity Generous Incentive opportunity Comprehensive benefits package available: including medical insurance, paid time off and paid holidays! Transport facility (As per policy and shift) - Transportation provided Working 5 days/week TSI Healthcare specializes in revenue cycle management, offering tailored solutions for healthcare providers to address third-party insurance claims denials, manage underpayments, and optimize reimbursement processes. The Claim Resolution Specialist plays a versatile role in the claims workflow, tasked with submitting appeals to overturn denials and trigger payments or determining whether further action, such as additional appeals or account closure, is required. Specialists in this role may prioritize tasks based on claim complexity and workload, ensuring optimal productivity while maintaining compliance and accuracy. By efficiently processing high volumes of low-balance claims, the specialist ensures compliance, accuracy, and revenue recovery that supports client success. Appeal Submission and Resolution: Prepare and submit well-documented and persuasive appeals for denied claims, leveraging payer guidelines, contracts, fee schedules, and medical records to resolve issues and trigger payments. Escalation Management: Address claims escalated by Claim Status Specialists, resolving complex denial scenarios such as coding disputes, medical necessity issues, or payer policy conflicts. Underpayment Resolution: Investigate and address discrepancies between expected and actual payments, taking corrective action to resolve underpayments. Final Determination: Evaluate claims to determine if they are resolved or require further action, such as additional appeals, escalation, or account closure based on client requirements. Account Closure: Review and close accounts when collection efforts have been exhausted, ensuring proper documentation and compliance with client guidelines. Account Review Feedback: Identify incorrectly resolved claims and return them to the appropriate team for review, correction, or training, contributing to process improvements. Collaboration: Utilize documentation provided by Document Retrieval Specialists and Claim Status Specialists to perform resolution activities efficiently High school diploma or equivalent required. Minimum of three years of experience in healthcare claims management, denial resolution, or appeal writing. · Experience in high-volume, low-balance claims processing preferred. Familiarity with payer-specific policies, reimbursement methodologies, and contract terms. Knowledge of coding principles (e.g., CPT, ICD-10, HCPCS) and medical necessity documentation is a plus This job description is not an exclusive or exhaustive list of all job functions that a team member in this position may be asked to perform. Duties and responsibilities can be changed, expanded, reduced, or delegated by management to meet the business needs of the company. We provide Equal Employment Opportunity for all individuals regardless of race, color, religion, gender, age, national origin, marital status, sexual orientation, status as a protected veteran, genetic information, status as a qualified individual with a disability and any other basis protected by federal, state or local laws INDJOBS
Posted 5 days ago
7.0 years
0 Lacs
Payum, Arunachal Pradesh, India
Remote
Position Summary We are seeking a strategic, results-oriented Director of Revenue Cycle to lead and optimize our revenue operations. This leadership role is vital to ensuring the financial performance, operational integrity, and regulatory compliance of the practice. The ideal candidate has deep experience in U.S. healthcare revenue cycle management, preferably within orthopedic or specialty care, and a strong track record of success in improving cash flow, managing payer contracts, and building high-performing teams. This position is ideally suited for someone based in Illinois with a strong understanding of state and federal healthcare regulations and payers. Key Responsibilities Own and lead the entire revenue cycle, from charge capture through final payment, ensuring efficient and compliant operations. Oversee functional teams in billing, coding, A/R, collections, payment posting, denial management, and revenue reconciliation. Drive key financial metrics including days in A/R, clean claim rates, denial rates, and collection effectiveness. Manage Managed Care Contracts, including payer negotiations, reimbursement modeling, implementation, and ongoing compliance. Collaborate cross-functionally with physicians, clinical staff, and operations to resolve billing issues and streamline workflows. Ensure compliance with federal/state healthcare regulations, payer requirements, HIPAA, and documentation standards. Identify, design, and implement process improvements to optimize efficiency, accuracy, and patient experience. Supervise the management of medical records and disability documentation in accordance with best practices. Lead, mentor, and develop a high-performing revenue cycle team aligned with organizational values and goals. Leverage data analytics to provide actionable insights and continuous performance improvement. Requirements Key Responsibilities Qualifications Bachelor's degree in Healthcare Administration, Business, Finance, or related field required; Master's preferred. 7-10 years of progressive revenue cycle experience in U.S. healthcare settings, with 3+ years in a director or leadership role. Demonstrated success in orthopedic or specialty practice RCM is strongly preferred. Expert-level knowledge of billing, coding (CPT, ICD-10), collections, A/R, denials, and reimbursement methodologies. Proven ability to negotiate and manage Managed Care and value-based contracts. Familiarity with Illinois payer landscape and regulatory requirements is highly desirable. Strong EHR/PM system proficiency (Athenahealth, Epic, or similar platforms). Excellent analytical, leadership, communication, and organizational skills. Experience managing remote or hybrid teams and working across diverse cultures and departments. Benefits At Genesis, we believe that ethical, affordable, and high-quality care should be a universal right—not a privilege. After 17 years of practicing conventional medicine, we reimagined healthcare from the ground up. Through hundreds of hours of research and innovation, we developed a model that maintains our clinical excellence while expanding access to those who need it most. If you're a forward-thinking revenue cycle leader with a passion for healthcare transformation, we'd love to hear from you.
Posted 5 days ago
0.0 - 2.0 years
0 Lacs
Bengaluru, Karnataka
Remote
Please Note: English language proficiency is required for this role. This is a full-time , work from office role. This requires a U.S. schedule - India Night shift. Work Location: This is a Work from Office position and location is Bangalore at: Block 12B, Pritech Park,3rd Floor, SEZ Survey No 51-64/4, Bellandur,Village. Bldg 9A Rd, Bengaluru –Karnataka 560103 Shift: Night Contact: Nirmala 911 301 5045 Build Your Future! Come join our thriving team as a Certified Medical Coder! We are seeking ambitious, self-motivated and driven people just like you for a rewarding career in the RCM Healthcare arena. Why should you consider TSI (part of TSI family of companies)? Paid training Team-oriented work environment Growth opportunity Generous Incentive opportunity Comprehensive benefits package available: including medical insurance, paid time off and paid holidays! Transport facility (As per policy and shift) - Transportation provided Working 5 days/week We are seeking a Certified Medical Coder to join our growing team. In this role, you will be responsible for reviewing and coding both hospital and physician-billed charges for accuracy and compliance with established billing and coding guidelines. You will also analyze supporting medical documentation and address coding-related denials to ensure optimal reimbursement. This role reports directly to a Supervising Attorney or Supervisor and requires the ability to work onsite. Review and assign appropriate codes for both facility (hospital) and professional (physician) billed services Ensure accuracy of ICD-10-CM, CPT, HCPCS , and modifier usage per payer guidelines Evaluate and resolve claim denials, including medical necessity and timely filing issues Provide feedback on payer denials and assist with the appeal process when appropriate Reference and interpret UB04, CMS-1500, EOBs , and RAs to support coding validation Collaborate with internal teams and external partners to resolve coding discrepancies Maintain up-to-date knowledge of industry standards, payer-specific rules, and coding regulations Work independently and maintain productivity standards in an onsite setting Use electronic health record (EHR) systems and documentation tools to access and update coding information Refer to written training resources and coding references as needed Certified Billing and Coding Specialist (CBCS) or AAPC Coder Certification (Advanced level required) Minimum of 2 years of experience coding hospital and/or physician claims Strong knowledge of ICD-10-CM, CPT, HCPCS, UB04 , and CMS-1500 forms Familiarity with Medicare, Medicaid, HMOs, PPOs , and managed care plan guidelines Proficient in medical terminology, healthcare documentation, and coding best practices Strong comprehension, problem-solving, and conflict resolution skills Excellent verbal and written communication skills in English Ability to work independently with minimal supervision Preferred Skills: Experience working in a fully remote coding or RCM environment Prior involvement in denial resolution and payer appeals Comfortable using multiple healthcare platforms and EHR systems Ability to analyze coding patterns and identify billing trends This job description is not an exclusive or exhaustive list of all job functions that a team member in this position may be asked to perform. Duties and responsibilities can be changed, expanded, reduced, or delegated by management to meet the business needs of the company. We provide Equal Employment Opportunity for all individuals regardless of race, color, religion, gender, age, national origin, marital status, sexual orientation, status as a protected veteran, genetic information, status as a qualified individual with a disability and any other basis protected by federal, state or local laws INDJOBS
Posted 5 days ago
7.0 years
0 Lacs
India
Remote
Position Summary We are seeking a strategic, results-oriented Director of Revenue Cycle to lead and optimize our revenue operations. This leadership role is vital to ensuring the financial performance, operational integrity, and regulatory compliance of the practice. The ideal candidate has deep experience in U.S. healthcare revenue cycle management, preferably within orthopedic or specialty care, and a strong track record of success in improving cash flow, managing payer contracts, and building high-performing teams. This position is ideally suited for someone based in Illinois with a strong understanding of state and federal healthcare regulations and payers. Key Responsibilities Own and lead the entire revenue cycle, from charge capture through final payment, ensuring efficient and compliant operations. Oversee functional teams in billing, coding, A/R, collections, payment posting, denial management, and revenue reconciliation. Drive key financial metrics including days in A/R, clean claim rates, denial rates, and collection effectiveness. Manage Managed Care Contracts, including payer negotiations, reimbursement modeling, implementation, and ongoing compliance. Collaborate cross-functionally with physicians, clinical staff, and operations to resolve billing issues and streamline workflows. Ensure compliance with federal/state healthcare regulations, payer requirements, HIPAA, and documentation standards. Identify, design, and implement process improvements to optimize efficiency, accuracy, and patient experience. Supervise the management of medical records and disability documentation in accordance with best practices. Lead, mentor, and develop a high-performing revenue cycle team aligned with organizational values and goals. Leverage data analytics to provide actionable insights and continuous performance improvement. Requirements Key Responsibilities Qualifications Bachelor's degree in Healthcare Administration, Business, Finance, or related field required; Master's preferred. 7-10 years of progressive revenue cycle experience in U.S. healthcare settings, with 3+ years in a director or leadership role. Demonstrated success in orthopedic or specialty practice RCM is strongly preferred. Expert-level knowledge of billing, coding (CPT, ICD-10), collections, A/R, denials, and reimbursement methodologies. Proven ability to negotiate and manage Managed Care and value-based contracts. Familiarity with Illinois payer landscape and regulatory requirements is highly desirable. Strong EHR/PM system proficiency (Athenahealth, Epic, or similar platforms). Excellent analytical, leadership, communication, and organizational skills. Experience managing remote or hybrid teams and working across diverse cultures and departments. Benefits At Genesis, we believe that ethical, affordable, and high-quality care should be a universal right—not a privilege. After 17 years of practicing conventional medicine, we reimagined healthcare from the ground up. Through hundreds of hours of research and innovation, we developed a model that maintains our clinical excellence while expanding access to those who need it most. If you're a forward-thinking revenue cycle leader with a passion for healthcare transformation, we'd love to hear from you.
Posted 5 days ago
4.0 years
0 Lacs
India
On-site
Job Title: Senior Bench Sales Recruiter Location: Hyderabad, India Job Type: Full-Time | Night Shift (U.S. Time Zone) Experience: 4 years (can be adjusted) Industry: IT Staffing / U.S. Recruitment Requirements: Bachelor’s degree in any discipline (preferred: HR, Business, or IT). 4 years of bench sales experience in U.S. IT staffing. Strong understanding of visa types: H1B, OPT, CPT, GC, USC, and tax terms (W2, C2C, 1099). Excellent communication and negotiation skills—verbal and written. Proven ability to market consultants effectively through job boards (Dice, Monster, CareerBuilder), LinkedIn, and vendor networks. Familiarity with VMS systems, ATS tools, and sourcing best practices. Ability to work independently and lead by example in a fast-paced, target-driven environment. Willingness to work night shifts (U.S. EST/PST hours). Interested can share your resume at giri@vitelglobal.com
Posted 5 days ago
4.0 - 6.0 years
0 Lacs
India
Remote
Job Title : Senior Bench Sales Manager – US IT Staffing (Remote – India) Company : Elegant Enterprise-Wide Solutions, Inc. Location : Remote (India) Experience Required : 4-6 Years Industry : US IT Staffing & Consulting (H1B) Tier 1 direct clients only** Job Summary: Elegant Enterprise-Wide Solutions, Inc. is seeking a highly experienced and proactive Senior Bench Sales Manager to join our remote team in India. The ideal candidate will have a proven track record in US IT staffing with a focus on Bench Sales, H1B transfers, and Tier 1 Vendor relationships. This is a results-driven role best suited for individuals who thrive in a fast-paced environment and can work independently while driving consistent placements. Key Responsibilities: Manage the entire lifecycle of Bench Sales for H1B, W2, and OPT/CPT consultants. Build and maintain strong relationships with Tier 1 vendors and direct clients. Aggressively market bench consultants through job boards, social platforms, and vendor networks. Revive and expand existing vendor relationships and develop new Tier 1 vendor networks. Coordinate with legal teams and vendors for H1B transfers, documentation, and onboarding. Work closely with consultants to gather project preferences and place them at higher rates. Negotiate client/vendor terms and manage communication until successful onboarding. Lead or support an offshore team for pipeline development, consultant submissions, and follow-ups. Ensure timely submissions, interview scheduling, and consultant status tracking. Monitor and place consultants in parallel or back-to-back projects to ensure continuous billing. Required Skills & Qualifications: Minimum 4–6 years of hands-on experience in US IT Bench Sales. Extensive knowledge of H1B processes, visa types, and compliance. Demonstrated ability to work with Top Tier 1 Vendors and direct clients. Strong background in handling H1B transfers and third-party consultants. Proficient in negotiation, rate finalization, and onboarding documentation. Proven experience in team leadership and ability to scale operations. Excellent verbal and written communication skills. Strong time management and organizational abilities. MBA in Marketing or relevant field preferred. Additional Preferences: Ability to work in a performance-driven environment with minimal supervision. Experience in placing consultants within tight deadlines and at competitive rates. Familiarity with remote tools and platforms for team coordination and tracking.
Posted 5 days ago
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