Senior Associate
Capgemini
Noida
10.2018 - Current
- Proficiency in CPT, Revenue Code, ICD-10 codes, UB-04 & CMS-1500 Health Insurance, Medical Terminology, HIPAA, Medicare, Medicaid, EOBs
- Experience in professional (HCFA), institutional (UB) claims
- Ability to review medical records, physician notes, EOBs, and COBs
- Skills in calculating patient responsibility and processing payments or denials
- Process Adjudication claims and resolve for payment and Denials
- Good Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations
- Monitored and managed the entire claims process, ensuring all transactions were completed accurately and within established timelines, consistently meeting or exceeding client SLAs.
- Reviewed medical records to ensure accuracy and completeness of diagnosis and procedure codes for billing purposes.
- Processed medical claims for members and dependents, including but not limited to eligibility determinations, claim submissions, benefit plan amendments, terminations of coverage, etc.
- Good Knowledge of claims processing and entire Claims life cycle for both Commercial as well as Government program claims for US Healthcare.
- Excellent interpersonal skills in communications, client relations
- Total experience of 6 years in Capgemini.