| Job Role | Appeals Associate (US Health Care Claims) |
| Company | Chcs Services |
| Salary | ₹3-₹4..5 LPA |
| Location | Work From Home |
| Eligibility | – Medical Graduates BHMS, BAMS, B.Pharma, M.Pharma, Biotechnologist, BTech (Biotech) – Graduates having 0-5 years of experience. |
Job Description
- Experience in reading medical summarization/Operative reports and derive the DX and procedures.
- The job involves working independently on researching, reviewing, summarizing, and recommending a course of action on claims where an appeal or a grievance has been filed for a denied / underpayment
- Should be able to prioritize work and adjudicate appeals as per turnaround time.
- To ensure claims are adjudicated as per the client/company guidelines. Provide continual evaluation of processes and procedures.
- To respond to and resolve claims received via emails.
- The candidate should be able to correctly calculate claim amounts for the customers.
- Complying with company regulations regarding HIPAA, confidentiality, and private health information
- Candidates should have in-depth knowledge of ICD 10, CPT, Surgery procedures, Revenue codes, Medical terminologies, Medical reports, Human Anatomy, Inpatient vs Outpatient claims, etc.
- Should have an experience of reading and comprehending Medical reports
- Transcription, Clinical Research, or Medical underwriting experience will be an added advantage.