Claims Adjudicator Job Vacancy in Calibrated Healthcare Network Gurgaon, Haryana – Latest Jobs in Gurgaon, Haryana – updated today
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Company Name : Calibrated Healthcare Network
Location : Gurgaon, Haryana
Position : Claims Adjudicator
Job Description : 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
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