Senior Executive

Position Title, Responsibility Level:Executive/Senior Executive

Function: 

Operations

Reports to  - 

Assistant Manager/Lead Assistant Manager

Span of Control – 

None

C – 15, Noida 

This position is responsible for reviewing, analyzing and interpreting medical Information to assess and determine appropriate next action steps which may lead to denial or payment of claims. 

Work is performed under general supervision according to established guidelines. This individual promotes capabilities from a customer perspective, aligning needs with the target offering by creating a customer self-service enabled platform for core customers.

• Responsible for reviewing and analyzing discrepancies by cross-verifying from different data sources
• Familiar with US Healthcare domain knowledge and understanding of healthcare regulations (HIPAA)
• Deep understanding of medical coding, billing, and medical terminologies
• Attention for detail, and Strong analytical skills for processing medical documentation
• Critical thinking and high independent decision making capability
• Proficiency in healthcare information systems
• Ability to navigate through multiple applications
• Operates with urgency in a real time service environment
• Meets individual goals while assisting team to meet team goals
• Defines, communicates and manages workflow and data coordination to support various implementation related reports (i.e., reporting, inventory, capacity reporting, and ad-hoc reports as needed by management)
• May perform other duties as assigned
• Making outbound calls to agent, hospitals, pharmacy and doctors office to capture missing or required information

• Productivity
• Quality
• Turn Around Time of work assigned

• Attendance & Schedule Adherence

Primary Internal Interactions:

• SME/AM/LAM/Manager for the purpose of reporting performance, escalation handling, clarifying concerns, and seeking support
• AM/LAM for the purpose of settling issues left unresolved by the SME and monthly evaluation of performance
• SME for the purpose of handling process related issues; queries and escalated transactions 
• QCA for the purpose of associate performance feedback and audit in order to update the training curriculum
• Mentors for the purpose of seeking clarifications and answering queries real time

• Critical thinking and high independent decision making
• Strong analytical, Reasoning, and problem solving skills
• Medium competency in excel skills
• Ability to comprehend in English (written and verbal) for structured communication, including drafting effective emails and instant messages (IMs) for internal and external teams, as well as making professional calls to agent, hospitals, pharmacy and doctors office
• Ability to respond to all inquiries within a timely manner
• Strong interpersonal and communication skills – both verbal and written
• Adaptability/Ability to interpret variable input details

• Good computer navigation skills
• Typing speed of 25 Words per Minute with 90% Accuracy 
• Proficiency in healthcare information systems
• Ability to navigate through multiple applications

• Familiar with US Healthcare domain knowledge and understanding of healthcare regulations (HIPAA)
• Deep understanding of medical coding, billing, and medical terminologies
• Ability to produce high quality in production in environment.
•  Ability to troubleshoot, identify user errors vs. system mapping errors (enrollment dates, method, system logic) 

• Ability to work independently
• Ability to understand and question established process guidelines for possible process improvements
• Attention for detail, and Strong analytical skills for processing medical documentation
• Possess keen sense of acquiring knowledge

• Adaptable and flexible to work in night shifts

• Bachelor’s degree in relevant field such as Biology, Biochemistry, Biotechnology, BPT, MPT, BDS etc
• Computer literacy
• Candidates with relevant business experience more than 1 year will be preferred

Annexure: 

Acknowledgement (acknowledge that the information contained in this document is factual and complete)

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 Candidate                                                                              Supervisor                               Date