Job Description:
This process works on identifying discrepancies between medical records and billed services for complex and high value claims by identifying Up-coding, Unbundling, Duplication, and Misrepresentation of services. They approve/deny claims & Identify provider aberrant behavior patterns. The associates prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT/ diagnosis codes, CMC guideline along with referring to client specific guidelines and member policies
Job Responsibilities:
-Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of
CPT/diagnosis codes , CMC guideline along with referring to client specific guidelines and member policies
-Adherence to state and federal compliance policies and contract compliance
-Assist the prospective team with special projects and reporting
Requirements
To be considered for this position, applicants need to meet the qualifications listed in this posting.
Required Qualifications:
-Medical degree – BHMS/BAMS/BUMS/BPT/MPT/ B.sc Nursing
-Proficient knowledge of Cardiovascular system , Respiratory system , Integumentary system , Ortho and various other surgeries , knowledge of medicine
-Knowledge of US Healthcare and coding desirable
-Attention to detail & Quality focused.
-Good Analytical & comprehension skills
– Experience Range – 0 to 4 years ( Fresher’s can apply)
Preferred Qualifications:
-Health Insurance knowledge, managed care experience preferred
-Claims processing experience is helpful.
-Medical record familiarity is preferred
About Company:
United Health Group Inc, top ranking health care company, headquartered in Minnetonka, Minnesota, U.S. It has offices in all 50 states and 125 countries. UHG is Fortune 500 Company.