Claims Adjudicator II Job Vacancy in Evolent Health Pune, Maharashtra – Latest Jobs in Pune, Maharashtra
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Company Name : Evolent Health
Location : Pune, Maharashtra
Position : Claims Adjudicator II
Job Description : It’s Time For A Change…
Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
Are we growing? Absolutely – about 40% in year-over-year revenue growth in 2018. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019, and one of the “50 Great Places to Work” in 2017 by Washingtonian. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.
What You’ll Be Doing:
Evolent is looking for bright and energetic individuals to be a Claims Adjudicator
Essential functions
Experienced level adjudicator providing analytical ability to review claim rules and workflows.
Responsible for adjudicating claims to maintain/comply with Service Level Agreements.
Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedures.
Ability to understand logic of standard medical coding (i.e. CPT, ICD-10, HCPCS, etc.).
Research CMS1500 & UB04 claim edits to determine appropriate benefit application utilizing established criteria.
Apply physician contract pricing as needed
Ability to resolve claims that require adjustments and adjustment projects
Identify claim(s) with inaccurate data or claims that require review by appropriate team members
Maintain productivity goals, quality standards and aging timeframes
Contribute positively as a team player
Complete special projects as assigned
Comply with all departmental and company Policy and Procedures
Key competencies/skill/success factors:
Ability to work in a team environment
Integrity and discretion to maintain confidentiality of members, employee and physician data
Knowledge of medical billing and coding
Knowledge of health insurance, HMO and managed care principles
Critical thinking skills and analytical ability to work, discover and outline systems related issues independently and within a team to provide resolution to work products
Attention to detail
Excellent interpersonal, oral and written communication skills
Strong attention to detail and organization
Able to work independently; strong analytic skills
Strong computer skills
Qualification and Experience
Associate or Bachelor degree preferred.
Experience in health insurance claims processing with a minimum of 2 to 3 years adjudication experience.
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