Process Executive - Voice
Location
Secunderabad | India
Job description
Job Description
Not Applicable
Qualification :
Graduate (exclusion :
BE/BTech/MCA)
- For Medical Management Bacheloru2019s degree in Nursing or any health science related field.
- For NA High School Equiv.
Responsibility :
Business / Customer :
Data Processes :
:
- u2022 Provide highest level of customer satisfaction.
- u2022 Strive to understand and resolve issues/queries at the first instance.
- u2022 Maintain the business controls as per the requirement.
For NA, Medical Management and Benefit Coding :
:
- u2022 Respond to data requests and generate clientspecified reports in a timely manner.
- u2022 Articulate/ communicate in a manner which is understood by clients / endusers.
Claims, RCM and Member Services :
- u2022 Efficiently Process predefined number of claims / enrollment as assigned with highest level of accuracy as agreed upon by the client.
For RCM :
- u2022 Escalating the issues recieved in different batches.
- u2022 Supporting the team to achieve the SLA and TAT associated with Correspondence, Payments, PIA, and Write off.
- u2022 Delivering the quality metrics as defined by Customers.
Voice Processes :
:
For Claims, RCM and Member Services :
- u2022 Make and Answer calls to and from customers/end users based on agreed time frames.
- u2022 Transfer calls involving next level of service to the appropriate department as per the given guidelines.
Project / Process :
- u2022 Develop a complete understanding of the Procedures.
- u2022 Complete transactions for data preparation, submissions, etc as defined in SOPu2019s.
- u2022 100% Process adherence to transaction processing timelines.
- u2022 Adhere to audit compliance ( SAS 70, SOX, Statutory Audit) of all processes as laid out in process documentation.
- u2022 Ensure process guidelines are followed and met as documented.
- u2022 Set productivity /Quality benchmark.
- u2022 Adhere to shift handover processes.
- u2022 Raise process related issues / concerns on time with process and team leads.
- u2022 Ensure to meet all Statistical, Financial and TAT metrics.
- u2022 Stay updated with the process knowledge / changes refer to knowledge updates/ repositories to effectively process transactions.
- u2022 Adhere to security practices set by organization.
- u2022 Provide updates and submit reports related to own area of work.
- u2022 Complete transaction / calls volumes in queue within specified Turn Around Time.
- u2022 Respond to data requests.
- u2022 Perform administrative duties which includes maintaining accurate records of information regarding received claims/treatment requests.
- u2022 Record data relating to production statistics, enduser related notes, etc as appropriate.
- u2022 Maintain confidentiality of all information, policies, and procedures as required by the Health Insurance Portability and Accountability Act (HIPAA) protocols.
- u2022 Raise process related issues/concerns to team leads/manager.
- u2022 Adhere to federal, state, URAC, clientspecified, and established best practices regarding utilization management.
- u2022 Adhere to program quality standards and maintain acceptable levels of performance, including but not limited to attendance, adherence to protocols, customer courtesy, and all other productivity and efficiency targets and objectives.
- u2022 Continuous contribution to process excellence/improvement.
- u2022 Participate in project and organization initiatives led by the Delivery leadership.
For Medical Management :
- u2022 Receive, login and file a variety of reports, client charts, client interactions and other documents as needed in the account.
- u2022 Efficiently prepare and/or assign a predefined number of cases/transactions with highest accuracy.
- u2022 Prescreen a claim/treatment request for completeness and determine if this is appropriate for further processing.
- u2022 Sort, upload and assign the claim/treatment request to a case administrator, nurse reviewer or physician reviewer.
- u2022 Follow up on all pending claims appropriately and initiate the next steps.
For Claims :
- u2022 Input enrollment/change data in a timely manner to coincide with transmittal to vendors and district payroll.
- u2022 Process claims documents with zero critical errors.
- u2022 Manage benefits documentation by assembling benefit packets, filing benefits paperwork.
- u2022 Read and analyze the Benefit Grid/Source document, understand the benefits and code the same in the application.
- u2022 Works on Blue Exchange, Benefit Narratives and related line of businesses.
For RCM :
- u2022 Follow up on all pending claims appropriately and initiate the next steps.
- u2022 Complete transactions for claims submissions, rejections, Payment posting as defined in SOPu2019s.
- u2022 Complete coding transactions with the required ICD, CPT and other requirements.
- u2022 Respond to data requests.
- u2022 Process claims, charges and coding with zero critical errors.
For Provider Services :
- u2022 Review and analysis of the provider application for completeness and accuracy.
- u2022 Perform verification of data through approved sources listed by the client.
- u2022 Collect all pertinent information from the provider, provideru2019s malpractice insurer, National Practitioner Data Bank (NPDB) and other sources as listed by the client.
- u2022 Receive and process new and renewal credential applications for a variety of credentials, certificates, Permits and waivers.
- u2022 Make outreaches to providers to collect missing/outdated information.
- u2022 Manage Inventory and work on files that require multiple follow ups with the provider.
For Member Services :
- u2022 Process enrollment documents with zero critical errors.
- u2022 Complete enrollment or disenrollment / query calls transactions in queue within specified Turn Around Time.
For NA :
- u2022 Develops, coordinates, and executes project plans.
People / Team :
- u2022 Contribute to and participate proactively in knowledge sharing sessions.
- u2022 Completes all mandatory assessment/ certifications as applicable.
- u2022 Align individual goals with team objectives (work cohesively with the team).
- u2022 Participate and contribute to organizational activities.
- u2022 Record own attendance and time sheet related data.
- u2022 Builds and maintains a cohesive cross organization/company project team ethos and fosters productive working relationships, optimally assigning tasks to team members.
For NA :
- u2022 Contribute towards updating knowledge assets, user manual, online help document.
- u2022 Contribute to teams Learning and knowledge development programs.
Must Have Skills
Employee Status : Full Time Employee
Shift : Day Job
Travel : No
Job Posting : Feb 29 2024
About Cognizant
Cognizant (Nasdaq-100: CTSH) is one of the world's leading professional services companies, transforming clients' business, operating and technology models for the digital era. Our unique industry-based, consultative approach helps clients envision, build and run more innovative and efficient businesses. Headquartered in the U.S., Cognizant is ranked 185 on the Fortune 500 and is consistently listed among the most admired companies in the world. Learn how Cognizant helps clients lead with digital at or follow us
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