Associate BPM Lead (Healthcare Claims QA)

at  UST Global

REQUIREMENTS:

• QA experience in claims
• 2 to 5 years of medical claims processing experience
• Knowledge in US healthcare practice, medical coding (ICD-10, CPT4, DRG, HCPCS), clinical documentation improvement, medical terminologies, EDI, and HIPAA protocols
• Bachelor’s Degree, preferably in the field of nursing, healthcare and allied medical profession
• Credential/Professional Certification related to current work is an advantage
• Experience with medical coding to include diagnosis coding and terminology is an advantage
• Ability to multi-task and follow documented claims processes with minimal supervision
• Excellent verbal and written business communication skills
• Strong attention to detail and the ability to make appropriate decisions based on information presented

SKILLS

Bpo,Healthcare,Claims

ABOUT UST

UST is a global digital transformation solutions provider. For more than 20 years, UST has worked side by side with the world’s best companies to make a real impact through transformation. Powered by technology, inspired by people and led by purpose, UST partners with their clients from design to operation. With deep domain expertise and a future-proof philosophy, UST embeds innovation and agility into their clients’ organizations. With over 30,000 employees in 30 countries, UST builds for boundless impact—touching billions of lives in the process

RESPONSIBILITIES:

• Review claims or modify existing claims according to the appropriate and applicable action
• Analyze claims to determine appropriate action to approve or deny action done by the agent
• Determine if accurate payment criteria for clearing pending claims based on defined policies and procedures were applied
• Research claims edits to determine if appropriate benefit application utilizing established criteria, applies physician contract pricing as needed for entry-level claims was applied by the claims processor
• Review if provider inquiries regarding claim adjudication were reviewed and addressed
• Ability to understand and apply knowledge of medical coding (if applicable) and various medical claims forms to the claims process
• Demonstrate ability to work on high volume of repetitive claims audit
• Demonstrate increasing productivity to meet minimum requirements while maintaining quality standards