Process Specialist - Voice
Location
Secunderabad | India
Job description
Job Description
Not Applicable
Qualification :
Graduate (exclusion :
BE/BTech/MCA
- For Medical Management College/ University degree holder.
- For NA High School/Equiv, Associates Degree preferred or equiv work experience.
Responsibility :
'Business / Customer :
Data Processes :
For NA, Claims, RCM, Provider Services and Member Services :
- u2022 Focus on enabling quality deliverables and enhancing customer satisfaction.
- u2022 Provide regular and meaningful updates and communicates to client, stakeholders and Team lead/management.
- u2022 Interact with customers (internal / external) to meet process deliverables.
- u2022 Manage and resolve escalations and issues raised by customers.
- u2022 Single point of contact for all knowledge related issues.
For Claims, RCM and Provider Services :
- u2022 Data accuracy with respect to client requirements.
- u2022 All required data to complete the provider database or provider profile needs to be captured with 100% accuracy in the client applications.
- u2022 Need to work on complex state mandate applications, where the timelines are very stringent.
- u2022 Minimize rework by developing First Time Right culture.
- u2022 Generate process improvement ideas for better productivity, accuracy & turnaround time.
- u2022 Participate as potential seed resources for staffing new engagements.
- u2022 Perform root cause analysis on the errors made by the team members.
- u2022 Handles Supervisor Calls and escalation calls.
For Medical Management and Provider Services :
- u2022 Check and update all missing information from the requests as required by customer/client.
- u2022 Monitor product updates and communicate product inquiries with the client.
u2022 Query Management :
Ensure minimum transactions are routed to the client and all procedural queries are handled in-house
For NA :
- u2022 Report performance dashboards on a periodic basis to the customer stakeholders.
- u2022 Engage with Customer and drive status report meetings.
Voice Processes :
For Claims, RCM and Member Services :
- u2022 Effectively communicate information on products/services or trouble shoot issues within the specified time frames as agreed upon with the client,.
- u2022 In a manner that is understandable by the end user/ customer.
- u2022 Connect with the customer & provide highest level of customer satisfaction.
Project / Process :
Data Processes :
:
- u2022 Perform transactions as per defined guidelines.
- u2022 Resolve process related queries within defined timelines.
- u2022 Provide periodic status reports to the team leader on performance, status and any escalations.
- u2022 Adhere to defined support and quality processes as per the guidelines.
- u2022 Maintain proper documentation of all the transactions.
- u2022 Perform quality assurance review wherever applicable basis the process requirement.
- u2022 Assist with audits and maintain strict level of confidentiality on all matters pertaining to provider and /or payers.
- u2022 Prepare professional communication, emails, letters to providers.
- u2022 Meet deadlines and ensure good follow in call and email tracking.
- u2022 Ensure that quality, efficiency and productivity standards and targets are met.
- u2022 Review productivity with each associate and recommends followup training if necessary.
- u2022 Analyze areas for improvement with an objective to meet program metrics.
- u2022 Report regular error feedback.
- u2022 Performs other duties as may be assigned.
- u2022 Focus on enabling quality deliverables and enhancing customer satisfaction.
- u2022 Provide regular and meaningful updates and communicates to client, stakeholders and Team lead/management.
- u2022 Participate as potential seed resources for staffing new engagements.
- u2022 Perform root cause analysis on the errors made by the team members.
- u2022 Minimize rework by developing First Time Right culture.
- u2022 Identify knowledge gaps and provides inputs to the training teams.
- u2022 Act as Internal Auditor for the process auditing the domainspecific metric.
- u2022 Take Initiatives to improve quality rankings and completing assignments on time.
- u2022 Respond to queries raised by the team and provide appropriate feedbacks.
- u2022 Participate in project and organization initiatives led by the Delivery leadership.
- u2022 Contribute new ideas and innovative approaches at work.
For Medical Management :
- u2022 Assist the associates in performing their tasks as per client, state and/or federal protocols as well as other related guidelines.
- u2022 Ensures that associates are informed and updated on changes in state rules, regulations and client protocols.
- u2022 Under the direction Team Lead/Team Manager, act as a resource person for specific regulations and protocols, to properly address issues and concerns on medical review process.
- u2022 Act as frontline in providing product updates and answering process related questions from process executives and senior process executives.
- u2022 Take charge of the operations in the absence Team Lead / Team Manager.
- u2022 Maintain acceptable levels of performance including but not limited to attendance, adherence, customer courtesy, and all other productivity and efficiency targets and objective.
- u2022 Monitor compliance of associates to established federal, state, URAC, client and protocols.
- u2022 Keep track of turnaround time of specific state reviews and coordinates with the process executives and senior process executives to facilitate release of medical review assessments on time.
- u2022 Report to the Team Lead/ Supervisor/ Manager on state review statistics, issues encountered complaints, etc and escalate unresolved issues as appropriate.
- u2022 Oversee the work of new hires and continuous coaching of the programu2019s staff with the assistance of the Team Lead.
- u2022 Complete a QC report and coach Nurse Reviewer/s regarding corrections and/or suggestions made in their review.
- u2022 Work closely with the Program Trainer in establishing and maintaining Program Manuals.
For Claims :
- u2022 Active participation in the process/knowledge transitions from business to Cognizant center.
- u2022 Successful client certification as Process trainer (offshore) and subsequent Offshore knowledge transfer.
- u2022 Responsible for review and updation of domain specifics SPOC for all queries before it is put forward to the client and create a repository of FAQs.
- u2022 Ensure any updates in state mandates, policy & procedures would reach the operations team in a timely fashion.
- u2022 Assist associates in processing tricky and high value transactions.
- u2022 Deliver and validate clientspecific metric deliverables.
- u2022 Responsible for claims adjudicated in a day.
- u2022 Adjudication of claims with zero critical errors Responsible for assisting with online research projects for claim and litigation matters.
- u2022 Responsible for preparing litigation files for archiving.
- u2022 Responsible for assisting with collections This includes payment processing, record keeping, correspondence composition, and damage invoice composition.
- u2022 Work effectively in team environment to coordinate all credentialing processes (ie Third party verification groups wherever applicable basis the process requirement).
- u2022 Support the floor on queries related to complex Benefit plans and Benefit plan analysis.
- u2022 Lead the daily huddle related to knowledge management.
- u2022 Advice and counsel employees on benefit related issues in accordance with the Certified and classified Master Agreements and Administrative Program enabling proper and complete utilization of existing and new benefits.
- u2022 Continuous contribution to process excellence/improvement.
- u2022 Perform task estimation.
- guide the service analyst on estimation.
For RCM :
- 'u2022 Perform quality assurance review on completed credentialing files.
- u2022 Responsible for the inventory of the respective hospital accounts and deliver the SLA parameters.
- u2022 Responsible for the agents working in the respective hospital accounts.
- u2022 Develop Provider Directory with accurate details of providers.
- u2022 Collect and verify all demographic information from the provider through different sources as deemed appropriate.
- u2022 Verify all education & hospital affiliations information of the providers.
- u2022 Receive and process provider database on a regular basis.
- u2022 Tracks progress of outstanding verifications from Schools and Hospitals.
- u2022 Works effectively in.
Must Have Skills
- Credentialing&Re-credentialing
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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