Job Summary
We are seeking a Process Specialist for our Healthcare division with 0 to 1 year of experience. The ideal candidate will have expertise in Advanced Excel and Claims Adjudication. This role involves working in a hybrid model with night shifts. The candidate should be proficient in English and have a keen interest in healthcare claims processing.
Responsibilities
Analyze healthcare claims data to ensure accuracy and compliance with regulatory standards.Utilize Advanced Excel skills to manage and manipulate large datasets for reporting and analysis.Perform claims adjudication tasks to determine the validity and accuracy of claims.Collaborate with team members to resolve discrepancies and improve claims processing efficiency.Provide support in the development and implementation of process improvements.Maintain up-to-date knowledge of healthcare regulations and policies.Communicate effectively with internal and external stakeholders to address claims-related issues.Ensure timely and accurate processing of claims to meet organizational targets.Participate in training sessions to stay current with industry best practices.Assist in the preparation of reports and documentation for management review.Contribute to the continuous improvement of claims processing workflows.Support the team in achieving performance metrics and quality standards.Demonstrate a commitment to customer service and operational excellence.
Qualifications
Possess strong technical skills in Advanced Excel for data analysis and reporting.Have experience in claims adjudication to ensure accurate and compliant claims processing.Knowledge of Medicare and Medicaid claims is a plus.Familiarity with commercial claims is an added advantage.Proficient in English with excellent reading writing and speaking skills.Ability to work night shifts in a hybrid work model.Strong attention to detail and problem-solving skills.Effective communication and collaboration abilities.Commitment to continuous learning and professional development.
Certifications Required
Certified Professional Coder (CPC) or equivalent certification in healthcare claims processing.
