Job Summary
We are seeking a Subject Matter Expert in Claims for our HealthCare division with 4 to 7 years of experience. The ideal candidate will have expertise in HealthCare Products Payment Posting Revenue Cycle Management and Claims. This hybrid role requires night shifts and offers an opportunity to make a significant impact on our operations and customer satisfaction.
Responsibilities
Analyze and interpret complex healthcare claims data to ensure accuracy and compliance with industry standards.Collaborate with cross-functional teams to streamline claims processing and improve efficiency.Provide expert guidance on payment posting and revenue cycle management to optimize financial outcomes.Develop and implement strategies to reduce claim denials and enhance reimbursement rates.Monitor and evaluate claims processing workflows to identify areas for improvement.Ensure adherence to regulatory requirements and company policies in all claims-related activities.Conduct training sessions for team members to enhance their understanding of claims processes and best practices.Utilize healthcare product knowledge to support the development of innovative solutions for claims management.Assist in the resolution of complex claims issues providing expert advice and recommendations.Maintain up-to-date knowledge of industry trends and changes in healthcare regulations.Prepare detailed reports and presentations on claims performance and improvement initiatives.Support the implementation of new technologies and systems to enhance claims processing capabilities.Foster a culture of continuous improvement and excellence within the claims team.Qualifications
Demonstrate proficiency in healthcare products and their application in claims management.Possess strong analytical skills and attention to detail in reviewing claims data.Exhibit excellent communication and collaboration skills to work effectively with diverse teams.Show a deep understanding of payment posting and revenue cycle management processes.Have a proven track record of successfully managing claims and improving financial outcomes.Display a commitment to staying informed about industry developments and regulatory changes.Be adept at using technology to enhance claims processing and reporting capabilities.
