Claims Quality Audit Representative

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Key Responsibilities:

Achieve individual productivity and quality standards.
Contribute to handling volumes as required by management.
Examine and identify overpayments in claims, secure savings through recovery, and communicate effectively to confirm and retrieve overpayments.
Maintain accurate recovery records and documentation.
Learn and adapt to various claim system platforms and analyze claim payments for validation of potential other payor liability.

Role Proficiencies:

Technical Skills: Proficiency in using E&I & M&R claims platforms. Experience with medical claims auditing and researching medical claims information. Knowledge of medical claims terminology, including CPT-4, J-codes, and ICD diagnosis procedure codes. Computer proficiency in Microsoft Office, including Word, Excel, and Outlook.
Soft Skills: Strong analytical and problem-solving abilities. Excellent attention to detail and accuracy. Effective communication skills for providing feedback and collaborating with team members. Ability to work independently and manage time effectively to meet productivity standards.

Experience:
2 - 5 Years
Salary:
3 LPA - 4.5 LPA
Diversity Candidate:
Yes
Location:
Hyderabad
Address:
Hyderabad
Primary Skills:
Medical Claims Auditing, Claims Data Analysis, E&I & M&R Claims Platforms, CPT-4, J-Codes, ICD Codes, Overpayment Recovery
Secondary Skills:
Microsoft Office Proficiency (Word, Excel, Outlook), Trend Analysis, Claims Payment Validation, Contract Interpretation, HIPAA Compliance
Industry:
Healthcare
Job Type:
Full time
Degree:
Bachelor's degree. Knowledge of medical claims terminology, CPT-4, J-codes, and ICD diagnosis proced