Job Description:
-Work on ICD-10 update and maintenance project
-Review all LCD and NCD policies maintained by CMS at least once each two-week production cycle to identify Contractor revisions to policies, new policies and retired policies.
-Edit the policy data using the database to assure that accurate and current policy data is delivered to our clients.
-Communicate with onshore stakeholders on a regular basis.
-Research and create policy appropriate code relationships and billing edits as specified in the data requirements for Clients requiring Medicare Data. Create reimbursement related edits like Medical necessity, Modifiers, frequency, POS etc. based on policy language and interpretation.
-Develop complex coding/ clinical relationships in an intelligent database, maintain approx. 3500 LCD/ NCD policies in bi-weekly production cycle.
-Work on Medicaid/ PQRS/ other value add projects as required
Desired Profile:
-Qualification – Graduates (BAMS, BHMS, BPH, B. Sc. or equivalent) with coding certification(must) like CPC/ CPC-H, CCS/ CCS-P from AAPC/ AHIMA.
-Experience Range -2 to 3 years of experience in medical Coding, Claims Reimbursement, Denial management (preferably post -certification)
-Strong clinical acumen and analytical abilities
-Excellent communication skills
-Tech savvy with good MS office skills
Experience: 2 – 3 Years
Industry Type- Pharma / Biotech / Clinical Research
Role Team Leader-Quality Assurance/Quality Control
Functional Area ITES, BPO, KPO, LPO, Customer Service, Operations
Education:
UG – Any Graduate – Any Specialization
PG – Any Postgraduate – Any Specialization
Doctorate – Any Doctorate – Any Specialization, Doctorate Not Required
Company Profile:
UnitedHealth Group (NYSE: UNH) is a diversified health and well-being company dedicated to helping people live healthier lives. Headquartered in Minnesota, the company offers a comprehensive array of products and services through six operating businesses: UnitedHealthcare Employer & Individual, UnitedHealthcare Medicare & Retirement, UnitedHealthcare Community & State, OptumHealth, OptumInsight and OptumRx. Through its family of businesses, UnitedHealth Group serves the entire spectrum of health care participants: individual consumers, employers, governments, commercial payers and intermediaries, physicians, hospitals, care professionals, and pharmaceutical and medical device manufacturers. UnitedHealth Group operates in all 50 states and internationally, and provides services to more than 75 million people worldwide.
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