Job description:
- Review and analyze medical records and claims data to ensure accuracy, completeness, and compliance with healthcare regulations and payer requirements.
- Verify that all necessary clinical documentation is included to support claim submissions and medical necessity.
- Identify and resolve inconsistencies, errors, or missing documentation in patient records or claims.
- Prioritize and manage workloads to ensure expedited and high-priority cases are processed within defined timelines.
- Collaborate with healthcare providers, coders, and billing staff to obtain or clarify necessary information.
- Ensure compliance with HIPAA, CMS, and other regulatory guidelines related to medical record handling and claims processing.
- Prepare accurate reports and summaries of claim findings, trends, and potential process improvements.
- Support internal audits and quality assurance initiatives by providing detailed documentation and analytical insights.
- Maintain a strong understanding of healthcare terminology, coding standards (ICD, CPT, HCPCS), and insurance claim procedures.
EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world's leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 54,000 employees spanning six continents. For more information, visit
www.exlservice.com.
EXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates. EXL will only extend a job offer after a candidate has gone through a formal interview process with members of EXL's Human Resources team, as well as our hiring managers.
EXL is the indispensable partner for leading businesses in data-led industries such as insurance, banking and financial services, healthcare, retail and logistics. We bring a unique combination of data, advanced analytics, digital technology and industry expertise to help our clients turn data into insights, streamline operations, improve customer experience, and transform their business. Our partnerships with clients are built on a foundation of collaboration - and we've been chosen as a partner by nine of the top ten leading US insurance companies, nine of the top 20 global banks, and six of the top ten US health care payers. We function as one team to make your goals our goals, whether that's unlocking the value of generative AI or embedding analytics into workflows that reduce risk or power your growth. Clients choose EXL as their transformation partner for many reasons. Our geographic diversity make talent all over the world instantly accessible. Digital accelerators enable unmatched speed-to-value, letting you realize results fast. It's our people that truly set us apart, though, including the 1,500 data scientists we have dedicated to our generative AI practice. And our more than twenty years of experience in delivering business services, garnering stellar client references, and maintaining a solid balance sheet are reassuring to our C-suite clients. Find out for yourself why clients, employees, and analysts think we're some of the best in the business. Contact us to see how we can help you achieve your goals. Qualifications: Any Graduate/ Postgraduate
Working Hours: 40 hours /week, Full Time Employee
Work Model: Training from office for 2 - months and hybrid there after
Telecommuter/Internet requirements, if applicable: High Speed internet connection and Power back up
Skills and abilities:
3-5 years of Experience.
Good communication, flexibility, reliability
Knowledge in Microsoft outlook/excel/word/PPT.
Strong Analytical skills with the ability to investigate and resolve issues
Familiarity with HIPAA, Medicare, Medicaid and other payer specific regulations.
NA
Responsibilities:
Complete the necessary training and meet the expectations outlined for the position.
Follow all standard operating procedures (SOP) diligently.
Complete audits promptly and ensure high quality.
Strive to meet both quality and production targets.
Adhere to project protocols and instructions.
Report any issues or trends promptly.
Maintain the logs (such as productivity, clarification, and others as applicable) updated.
Seek clarification from the manager or team leader when needed.
Promptly respond to all emails from the manager.
Ensure compliance with all relevant regulations and policies.
