Claims Adjudicator Job in Calibrated Healthcare

Claims Adjudicator

Gurugram, India

Calibrated Healthcare Network (CHN) is a decade old healthcare firm that provides a suite of services across three service lines; Healthcare Administration, Medical Management and Population Health Management. Calibrated s unique Operating Model combines acclaimed clinical/operational leadership with a Hybrid Global Footprint to deliver distinctive value to clients. Our extensive and proven expertise in managed care sets us apart; managing over 11 million lives in over 8 states, with clients that include the dominant national and regional players in the industry

Position Purpose

At Calibrated, we are looking for experienced Claims Examiners/Claims Adjudicators to join our operations team in Gurugram who will directly work with the Claims Manager to process accurate claims according to regulatory guildelines.

Duties and Responsibilities

• Evaluates and processes claims in accordance with company policies and procedures, CMS and DMHC guidelines
• Reviews and analyzes data for in-process claims in order to identify and resolve errors prior to final adjudication
• Exercises good judgment and remains knowledgeable in related company policies and procedures
• Achieves teamwork, production and quality standards in order to assure timely, efficient and accurate claims processing
• Conveys a strong professional image, exhibits interest and positive attitude toward all assigned work

Education and Experience

• Minimum 2 years of work experience in US Health care industry in Claims Adjudication
• Extensive knowledge of Commercial, Medi-Cal/Medicaid and Medicare claims processing guidelines
• Knowledge of medical coding/billing including ICD-10, CPT, CMS-1500, UB-04 etc.
• Knowledge of different providers payment methodologies (i.e., capitation, fee for service based on RBRVS, Medicaid and other negotiated flat rates, RVS pricing, Per Diem, DRG pricing, etc.), preferred
• Minimum Bachelor s Degree