Wipro Limited
Key member of the Operational team responsible for supporting claim and call projects. As a member of this team, you will be supporting health care administration. Strong organizational skills, collaboration, and attention to detail are required to ensure success. Projects include specialized functions of medical claims payment.
Responsibilities include:
HBRs (Hospital Bill Reviews):
Coordinate data transfer with responsible teams for high-dollar claims requiring review. Follow-up to ensure timely responses. Escalate any grievances or disputes tied to these reviews for prompt resolution.
DRGs:
Using a stand-alone tool, validate that DRG codes billed on claims align with the grouper based on provider coding. Assist in collecting and updating data for Performance Guarantees reporting related to Quality and TAT.
NY Surcharge:
Complete monthly NY Surcharge reporting and send quarterly client lists.
Documentation:
Assist in creating and updating the Standard Claims Processing Manual and other Operating Procedures.
HIPAA:
Validate alternate communication directives received from members. Update documentation to ensure clarity and archive requests to support audits. This activity includes handling member requests to release medical information to third parties and managing alternate address communication requests.
Social Meeting:
Provide primary support for weekly production/resolution meetings. Responsibilities include updating logs, taking meeting notes, and driving the team toward resolution of open issues.
Other duties as assigned.
Qualifications:
At least 3 years of experience in health care administration.
Highly motivated self-starter.
Strong organizational skills to ensure effective cross-team collaboration.
Proficiency in Microsoft Office.
High School Diploma required; Associate's degree preferred.
About the company Wipro Limited is a leading global information technology, consulting, and business process services company. We harness cognitive computing, hyper-automation, robotics, cloud, analytics, and emerging technologies to help clients succeed in the digital world. Recognized globally for our comprehensive services, commitment to sustainability, and good corporate citizenship, we employ over 180,000 staff across six continents. We aim to discover ideas and connect dots to build a better future.
Notice Talentify is an Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.
Reasonable accommodations are provided for qualified applicants with disabilities or disabled veterans. Contact accessibility@talentify.io or call 407-000-0000 for assistance.
All new hires must complete Form I-9 and provide proof of identity and U.S. work eligibility.
An Automated Employment Decision Tool (AEDT) will score your skills and responses. For bias audit & data-use details, visit www.talentify.io/bias-audit-report. NYC applicants may request alternative processes or accommodations at aedt@talentify.io or 407-000-0000.
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Responsibilities include:
HBRs (Hospital Bill Reviews):
Coordinate data transfer with responsible teams for high-dollar claims requiring review. Follow-up to ensure timely responses. Escalate any grievances or disputes tied to these reviews for prompt resolution.
DRGs:
Using a stand-alone tool, validate that DRG codes billed on claims align with the grouper based on provider coding. Assist in collecting and updating data for Performance Guarantees reporting related to Quality and TAT.
NY Surcharge:
Complete monthly NY Surcharge reporting and send quarterly client lists.
Documentation:
Assist in creating and updating the Standard Claims Processing Manual and other Operating Procedures.
HIPAA:
Validate alternate communication directives received from members. Update documentation to ensure clarity and archive requests to support audits. This activity includes handling member requests to release medical information to third parties and managing alternate address communication requests.
Social Meeting:
Provide primary support for weekly production/resolution meetings. Responsibilities include updating logs, taking meeting notes, and driving the team toward resolution of open issues.
Other duties as assigned.
Qualifications:
At least 3 years of experience in health care administration.
Highly motivated self-starter.
Strong organizational skills to ensure effective cross-team collaboration.
Proficiency in Microsoft Office.
High School Diploma required; Associate's degree preferred.
About the company Wipro Limited is a leading global information technology, consulting, and business process services company. We harness cognitive computing, hyper-automation, robotics, cloud, analytics, and emerging technologies to help clients succeed in the digital world. Recognized globally for our comprehensive services, commitment to sustainability, and good corporate citizenship, we employ over 180,000 staff across six continents. We aim to discover ideas and connect dots to build a better future.
Notice Talentify is an Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.
Reasonable accommodations are provided for qualified applicants with disabilities or disabled veterans. Contact accessibility@talentify.io or call 407-000-0000 for assistance.
All new hires must complete Form I-9 and provide proof of identity and U.S. work eligibility.
An Automated Employment Decision Tool (AEDT) will score your skills and responses. For bias audit & data-use details, visit www.talentify.io/bias-audit-report. NYC applicants may request alternative processes or accommodations at aedt@talentify.io or 407-000-0000.
#J-18808-Ljbffr