15 Medical Claims Jobs

Urgent Job Opening Quality Assurance, Quality Control, Clinical Research , Regulatory Affairs, Medical Record Summarization , Medical Claims , Medical Officer, Medical Billing , Pharmacist, ADL, ARD, FRD, CDM, Production, R&D , Lab Technician

Involved in Analyzing Medical Reports to Process Medical Claims. Processing/Approving Medical claim Scrutinizing medical documents Providing Medical opinions Medical Audit Checking the validation of Hospitalization.

Contact insurance companies in the US to follow up on unpaid or denied medical claims Review patient account information resolve denials or rejections Work on hospital billing claims Analyze denial codes, understand reason for denials Required Candidate profile Document update the system with call outcomes and next steps Ensure adherence to HIPAA guidelines internal quality std Meet daily and weekly targets for call volume resolution Communicate effectively Perks and benefits Perks and Benefits

Role:AR Analyst( Medical Billing background) Exp: 0.6-1 year Salary: 21k Must Have : Resolve issues related to unpaid medical claims, denied claims Review and appeal unpaid and denied claims. Shift:General Location: Chennai Regards Sowmiya 9600445623

Urgent Job Opening Quality Assurance, Quality Control, Clinical Research , Regulatory Affairs, Medical Record Summarization , Medical Claims , Medical Officer, Medical Billing , Pharmacist, ADL, ARD, FRD, CDM, Production, R&D , Lab Technician

Experience: 0-12 months Qualification: BDS, BHMS, BAMS Key Responsibilities: Good communication skill. Knowledge in computers like MS office. Good medical knowledge. Independently process Post hospitalization claims; process complex claims with minimal assistance Needs to validate the information on all medical claims received. Claims must be thoroughly reviewed and ensure that there is no missing or incomplete information Suggest operational policies, workflows and process improvement initiatives Proactive approach by informing Providers regarding missing or repetitive errors by various hospital departments and improvisation of the same. Applying medical and surgical aspects to scrutinize the patient reports and other documents. Application of medical knowledge to bifurcate the claims. Analyzing and justifying the care and management given to the patient Thorough understanding of medical terminology in relation to diagnosis and procedures and meeting daily targets. Updating skills and medical knowledge with routine enhancement programs. Adjudication of claims as per the office memorandum of the concern scheme protocols Responsible for the accurate and timely processing of post discharge cashless claims. Meets quantity and quality claims processing standards. In-depth understanding of the hospitals processes, policies and procedures Verify Medical, billing related documents for further claim processing. What We Offer: Opportunities for professional development and career advancement. A collaborative and dynamic work environment.

Urgent Job Opening Clinical Research Associate , Quality Assurance, Quality Control, Regulatory Affairs, Medical Record Summarization , Medical Claims , Medical Officer, Medical Billing , Pharmacist, ADL, ARD,FRD, CDM, Production ,R&D ,Lab Technician

Urgent Job Opening Quality Assurance, Quality Control, Clinical Research , Regulatory Affairs, Medical Record Summarization , Medical Claims , Medical Officer, Medical Billing , Pharmacist, ADL, ARD, FRD, CDM, Production, R&D , Lab Technician

Hiring for UHG Process International BPO ???? Location: Andheri & Malad Process: UHG (Voice as applicable) Shift: US Shift / Night Shift Salary: Up to ?42,000 in-hand (depending on last drawn salary) Eligibility: Graduate Freshers & Experienced candidates can apply Excellent communication skills (written & verbal) Comfortable with night shifts Job Highlights: 5 days working, 2 days rotational week off Attractive salary with performance-based incentives Excellent work environment with growth opportunities Additional Information: Immediate joiners preferred Candidates must be comfortable working from office Benefits: Attractive salary package + incentives. 5-day work week with 2 rotational offs. Excellent growth opportunities within the organization. Interested candidates can Call or WhatsApp on- 9326479640 Regards, Vibrantzz Management Services,

Job description URGENT OPENING FOR MEDICAL OFFICER Workings Hours: 9 Hrs Work Mode : Office Key Responsibilities: Review and assess medical claims submitted by corporate clients against policy terms and medical guidelines. Analyze clinical documents such as medical reports, diagnostic tests, prescriptions, discharge summaries, and other relevant medical records. Verify the authenticity, appropriateness, and completeness of medical documentation related to claims. Provide medical expertise to determine the validity and admissibility of claims. Collaborate with claims processing and underwriting teams to resolve discrepancies or clarifications related to medical information. Identify potential fraud, over-utilization, or discrepancies in claims through thorough medical evaluation. Maintain up-to-date knowledge of medical terminologies, treatment protocols, and emerging health trends relevant to claims assessment. Assist in developing and updating medical claim processing guidelines and protocols. Support training and capacity-building activities for claims staff on medical aspects of claims. Ensure compliance with regulatory and company policies during claims assessment. Communicate effectively with healthcare providers, corporate clients, and internal teams to clarify medical information as needed. Generate detailed reports and documentation on claim assessments and decisions. Qualification: BHMS, BMS

Our reputed MNC Client is hiring for Nurse Reviewer role: Shift: 11:30 AM - 8:30 PM Work Mode: Work From Office (5 days) Location: Hyderabad Job Summary: We are seeking an experienced Nurse Reviewer to conduct in-depth claim reviews based on medical guidelines, clinical criteria, and billing rules. The ideal candidate will have a strong understanding of medical coding, clinical experience, and excellent communication skills. Key Responsibilities: - Conduct claim reviews to identify areas with savings potential - Review and validate charges against medical documentation - Contact medical providers to resolve billing inconsistencies - Manage claims reports and prioritize according to client stipulations - Maintain production metrics and quality assurance scores Requirements: - Current RN/LPN license - Varied clinical experience (Med/Surgery, ICU, Emergency Medicine) - Understanding of hospital coding and billing rules - Experience in medical claims review and audit techniques - Excellent communication and organizational skills Preferred Qualifications: - Background as a nurse or doctor - 4-5 years of hands-on experience in medical coding - Strong understanding of medical coding related to post-operative care, joint replacement, spinal surgery, and cardiac surgery procedures Warm Regards, Gayatri Kumari Email Id: gayatri@v3staffing.in V3 Staffing Solutions

Immediate Job Openings for our Pharma Clients Job Profile Quality Assurance, Quality Control , CRA , R & D , Pharmacist , Medical Claims , Medical Record summarization , Medical Billing , Medical Writer , BDM , CDM , RA Production ,

Review and analyze insurance claims for accurate submission. Follow up with insurance companies via phone calls Resolve denied or unpaid claims Document call details Understand and interpret EOBs, denial codes, and claim adjustments. Required Candidate profile Excellent spoken English Knowledge of medical billing terminology (CPT, ICD-10, modifiers). Familiarity with US healthcare RCM cycle. Strong understanding of denial management and claim reprocessing. Perks and benefits Perks and Benefits

Provides clinical review expertise for high dollar and complex claims, including facility and professional bills. Provides cost containment services by identifying coding and billing errors and insuring application of Medical and Reimbursement Policies. Additionally identifies cases for potential fraud and abuse and makes referrals. Major Job Responsibilities Evaluates medical information against criteria, benefit plan, coverage policies and determines necessity for procedure and refers to Medical Director if criteria are not met Evaluate itemized bills against reimbursement policies Adheres to quality assurance standards Serves as a resource to facilitate understanding of products Handles some escalated cases; secures supervisory assistance with problem solving and decision making Advises supervisory staff of any concerns or complaints expressed by Health Care Professionals Utilizes effective communication, courtesy and professionalism in all interactions, both internally and externally Performs additional unit duties below as appropriate: Participate on special projects. Perform random or focused reviews as required. Support and assist with training and precepting as required Analyze clinical information Perform claim reviews with focus on coding and billing errors Identify and refer cases for possible fraud/abuse or questionable billing practices to the appropriate matrix partners Handle multiple products and benefit plans Works under moderate direct supervision. Qualifications MBBS. Maintain active Medical as required by state and company guidelines Clinical experience in hospital/clinic for 3 or more years Team player Flexible/Adaptable Excellent time management, organizational, and research skills Experience with MS Office Suite (Outlook, Excel, Access, SharePoint) Preferred Qualifications Utilization Review or Claim Review experience in Health insurance Knowledge of the Principles of Health Care Reimbursement Key Skills and Competencies Strong background in quantitative decision making, ability to drive business/operations metrics Metrics-driven. Able to translate strategy into measurable operational goals and objectives. Disciplined in assessing performance and addressing problems. Good communication and strong interpersonal skills. Highly organized, structured & proactive. Good inter-cultural skills & Exposure to global work environment. Good time management skills - meet tight timelines and manage ad hoc deliverables, if any.

Medical Claims Review Senior Analyst/Clinical supervisor Complex Claim Unit Provides clinical review expertise for high dollar and complex claims, including facility and professional bills. Provides cost containment services by identifying coding and billing errors and insuring application of Medical and Reimbursement Policies. Additionally identifies cases for potential fraud and abuse and makes referrals. Major Job Responsibilities Evaluates medical information against criteria, benefit plan, coverage policies and determines necessity for procedure and refers to Medical Director if criteria are not met Evaluate itemized bills against reimbursement policies Adheres to quality assurance standards Serves as a resource to facilitate understanding of products Handles some escalated cases; secures supervisory assistance with problem solving and decision making Advises supervisory staff of any concerns or complaints expressed by Health Care Professionals Utilizes effective communication, courtesy and professionalism in all interactions, both internally and externally Performs additional unit duties below as appropriate: Participate on special projects. Perform random or focused reviews as required. Support and assist with training and precepting as required Analyze clinical information Perform claim reviews with focus on coding and billing errors Identify and refer cases for possible fraud/abuse or questionable billing practices to the appropriate matrix partners Handle multiple products and benefit plans Works under moderate direct supervision Qualifications MBBS or BSc/MSc Nursing. Maintain active Medical/nursing license as required by state and company guidelines Clinical experience in hospital/clinic for 2 or more years Team player Flexible/Adaptable Excellent time management, organizational, and research skills Experience with MS Office Suite (Outlook, Excel, Access, SharePoint) Preferred Qualifications Utilization Review or Claim Review experience in Health insurance Knowledge of the Principles of Health Care Reimbursement Key Skills and Competencies Strong background in quantitative decision making, ability to drive business/operations metrics Metrics-driven. Able to translate strategy into measurable operational goals and objectives. Disciplined in assessing performance and addressing problems. Good communication and strong interpersonal skills. Highly organized, structured & proactive. Good inter-cultural skills & Exposure to global work environment. Good time management skills - meet tight timelines and manage ad hoc deliverables, if any.