HC and Insurance Operations Analyst

Role Responsibilities:

• In-depth knowledge and experience in the US healthcare (Non Voice) – Provider Data Validation and Provider Data management.
• Candidate should have 3 years and above experience in US healthcare and into provider enrollment and credentialling.
• Ensures day-day transactions are processed per standard operating procedures.
• Follows Work process flow to ensure pends are completed and maintain Quality and timeliness standards.
• Knowledge in Amisys and Cenprov application are preferred.
• Product knowledge in checking affiliation for Medicaid, Medicare and Exchange.
• Everyday checked Contract information in Payment Index such as, Pay class, override key, accepts code and etc.
• Ability to read and understand the provider contract.
• Handling Paid claims and recouped claims.
• Claims Rejections handling.
• Working in claims denial management.
• Knowledge about End to End provider billing process.
• Working knowledge in EDI rejection claims
• Handing Patient and provider demographic changes.

Required Skills:

• 3 to 5 years of experience in US healthcare working with Provider Data Enrollment and Management.
• Ability to work in a 24/5 environment; shifts can be rotational.
• University degree or equivalent that required 3+ years of formal studies.
• Ability to work in a team environment.
• Good logical thinking ability.
• Good English Comprehension/written skills should have exposure to MS Office.
• Good Communication Skills – Both Verbal and Written
• Ability to interact with clients preferred.

 

  **Required schedule availability for this position is 24/5 and the shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend’s basis business requirement.

Experience Level

Entry Level