Medical Claims Processor - Aguadilla Pueblo, Puerto Rico - IBPO USA

Descripción

Job Description
:

In the role of process associate, you will execute transactions as per prescribed guidelines and timelines, reviews and validates the inputs from the other team members, support your manager in training activities, daily operations reviews and help in escalation resolution with the objective to meet service level agreement targets for the specific process within the guidelines, policies and norms of Infosys.

In this role you will be responsible for transition coordination, process training and certifications for the team, talent management related activities, Service Level Agreement compliance and Process compliance.

You will also be involved in day-to-day customer interactions, knowledge management and process reengineering activities.
Location for this position is Aguadilla, Puerto RicoBasic Qualifications

• High School Diploma or GED Equivalent

Minimum 18 to 36 months in Healthcare claims areaPreferred QualificationsExperience in Healthcare Claims adjudicationRequires in depth knowledge of CPT, ICD-9/10, and HCPC codesResponsible for accurate and timely processing of Healthcare claim service request and processing claimsReviews, evaluates the service request as per SOPFamiliar with Medical Policy, Familiar with UCSW service requests, correspondence inquiries and image reviewExperience in any claim adjudication platformTeam WorkMust be detailed orientedCritical thinking and problem solvingAccountability, Adaptability and flexibilityMotivated and ability to learn quicklyEnergetic and ability to take constructive feedbackDemonstrated ability to work in a production focused environmentGood verbal and written English communicationResponsibilities Include but may not be limited to:

• Prep medical records for clinical review
• End to end processing and resolution of clinical claims and correspondence
• Understand/interpret medical terminology including clinical notes and reports
• Able to review medical policies and determine the appropriate claim processing or clinical review process decisions (pay, request additional records, refer for clinical review)
• Review and determine pricing for clinical claims in accordance with negotiated pricing agreements
• Adept knowledge of verifying member benefits, eligibility verification and medical necessity determination
• Forward the cases to appropriate teams, post the in-scope activities have been completed as per SOP
• NASCO claim processing – adjustments and manual pricing
• Should be knowledgeable in the use of intranet (OLI, Image, Sharepoint etc) and internet (CareRadius, Encoder Pro, EviCore etc) applications
• Lotus Notes where the Medical Policy Database, NAEGS and OTT Database are housedWho We AreInfosys BPM Limited, a wholly owned subsidiary of Infosys Limited (

NYSE:
INFY), provides end-to-end transformative business process management (BPM) services for its clients across the globe.

The company's integrated IT and BPM solutions approach enables it to unlock business value across industries and service lines, and address business challenges for its clients.

Utilizing innovative business excellence frameworks, ongoing productivity improvements, process reengineering, automation, and cutting-edge technology platforms, Infosys BPM enables its clients to achieve their cost reduction objectives, improve process efficiencies, enhance effectiveness, and deliver superior customer experience.

Infosys BPM has 45 delivery centers in 16 countries spread across 5 continents, with 56, employees from nationalities, as of December, .The company has been consistently ranked among the leading BPM companies globally and has received over 60 awards and recognitions in the last 5 years, from key industry bodies and associations like the Outsourcing Center, SSON, and GSA, among others.

Infosys BPM also has very robust people practices, as substantiated by the various HR-specific awards it has won over the years.

The company has consistently been ranked among the top employers of choice, on the basis of its industry leading HR best practices.

The company's senior leaders contribute widely to industry forums as BPM strategists.

EOE/Minority/Female/Veteran/Disabled/Sexual Orientation/Gender Identity/National OriginInfosys BPM is an equal opportunity employer and all qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, spouse of protected veteran, or disability.