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Post : Associate III, Service Delivery Healthcare
Purpose:
• Responsible for providing professional and analytical support to medical services programs, including implementation, operation and contract compliance (e.g., Medicare); Utilization Review; Condition Management; Health Care Coordination; Case Management; Insurance Claim Administration; Pharmacy Services; Medical Services; Collection Services; Negotiates liability settlement of medical claims with third parties or healthcare providers; seeks reimbursement from healthcare providers and/or ensures payment of claims by appropriate insurance carrier.
• Insurance:Provides administrative support to the claim processing function.
• Eligibility: Position is responsible for gathering information related to applications for public assistance programs.
• Patient Accounting Specialist: Provides administrative support to the hospital billing department.
General:
• Senior level job with considerable work experience
• Has developed specialized skills or is multi-skilled through job-related training
• Completes a variety of atypical assignments
• May solve problems of a recurring nature, but takes a broad perspective to problems and may identify new, less obvious solutions
• Completes work with a limited degree of supervision
• Acts as an informal resource for colleagues with less experience
• May lead a team in the performance of a variety of tasks that are generally routine
• May have specialized external certification (technical roles)
Primary Responsibilities:
• Insurance Job roles may perform one or more of the following:
• Researches unpaid and denied claims to determine course of action.
• Checks the accuracy and completion of routine and complex claim forms.
• Maintains employee benefits records.
• Eligibility roles may perform one or more of the following:
• Reviewing applications submitted.
• Identifying required client data.
• Verifying data in support of the public assistance eligibility determination.
• Communicating with clients.
• Reviewing case information and preparing it for case disposition by the state eligibility consultant.
• Patient billing roles may perform one or more of the following:
• Performs analyses and manages the day-to-day operations of the billing process.
• Reviews and analyses each billing cycle to ensure accuracy.
• Researches billing issues. Responds to telephone inquiries and complaints.
• Obtains supporting documentation when needed.
• All other duties as assigned.
Additional Information
Location : Andhra Pradesh-Hyderabad
Qualification : Graduate
Industry Type : Pharma/ Healthcare/ Clinical research
Functional Area : Service Delivery Healthcare
End Date : 5th June, 2018
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