Associate III - BPM

Skill Examples:

1.     Customer Focus: Focus on providing a prompt and efficient service to customers goes out of the way to ensure that individual customer needs are met.
2.     Attention to detail to ensure SOPs are followed and mistakes are not knowingly made
3.     Team Work: Respect others and work well within the team.
4.     Communication: Speak clearly and write in a clear and concise manner. Uses appropriate style and language for communication (Data)
5.     Communication: Speaks in an accent neutral manner or with the accent required for the process with good vocabulary and grammar skills. Writes clearly (Voice)
6.     Typing Speed with 15WPM and 80% accuracy
7.     Analytical approach: Makes systematic judgments based on information and relevant assumptions.
8.     Ability to follow SOP documents and escalate the s within the defined SLA Willingness and ability to learn new skills domain knowledge etc.
9.     Make rule based and discretionary decisions.
10.  Process Trainer/Sr. QA/Domain Expert/MIS Analyst
11.  Frontline resource - Voice/Backoffice Quality Auditors SME Domain Experts

Knowledge Examples:

1.     Expertise with Windows Operating Systems MS Office tools    English comprehension – Reading writing and speaking
2.     Domain knowledge based on process (healthcare banking investment F&A retail customer support etc)
3.     Familiarity with work allocation and intake functions
4.     Familiarity with quality control processes including pare to analysis and root cause analysis
5.     Knowledge on security policies and tools
6.     Good understanding of customer infrastructure ability to co-relate failures
7.     Experience level – 3 to 7 years

Skillset: • High school degree required; Bachelor’s degree preferred with three (3) plus years of relevant professional experience in Healthcare claims operations for a large national/regional or Blues health plan or insurance company and/or TPA. • Previous Claims Adjuster experience. • Knowledge of physician practice and hospital coding, billing and medical terminology, CPT, HCPCS, ICD-9 and ICD-10. • Experience with UB/Institutional (UB04); Professional (CMS1500) claims and HIPAA-compliant EDI formats for claims related exchanges. Understand CMS guidelines for claims processing. • Strong experience in the analysis and processing of claims, utilization review/quality assurance procedures, CMS payment methodologies (i.e. Medicare Physician Fee Schedule, DRGs, Anesthesia, etc.) • Must be able to work with minimal supervision. • Creative thinker with good problem resolution skills related to the healthcare claim adjudication. • Strong experience on how to review what services have been Authorized by Utilization Review. • Maintain a full comprehensive understanding of the covered benefits, coding and reimbursement policies and contracts. • Self-starter who is highly motivated to get the job done. • Excellent verbal and written communication skills. • Proficiency with MS Office applications, especially Word and Excel.

Skills

Hipaa,Healthcare,Ms Office