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Transaction Quality Assurance Sr. Assoc.

3.00 to 5.00 Years   Coimbatore,India   25 Jun, 2023
NTT Data
Job LocationCoimbatore,India
EducationNot Mentioned
SalaryNot Mentioned
IndustryIT / Computers - Software
Functional Areahealthcare insurance
EmploymentTypeFull-time

Job Description

  • Experienced level adjudicator providing analytical ability to review claim rules and workflows.
  • Reviews claim requests to determine eligibility for processing and escalate to management as necessary.
  • Responsible for the coordination and resolution of the administrative denials and appeals
  • Ability to understand logic of standard medical coding (i.e. CPT, ICD-10, HCPCS, etc.).
  • Ability to resolve claims that require adjustments and adjustment projects , Identify claim(s) with inaccurate data or claims that require review by appropriate team members.
  • Organizing and completing tasks per assigned priorities.
  • Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team
  • Resolving complex situations following pre-established guidelines
  • Assists with transaction processing and detects errors in transaction.
  • Performs transactional quality based on audit parameters.
  • Classifies errors based on the type of the error and assigns root causes for errors.

Keyskills :
Medical CodingTransaction Processingquality audit

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