Job Description: •Strong understanding of U.S. healthcare applications, reimbursement policies, and claims adjudication systems.
Extensive experience reviewing multiple claim types and identifying processing errors, payment discrepancies, and incorrect claim handling.
Proven expertise in investigating system edits, configuration issues, and application glitches that result in inaccurate claims adjudication or payment outcomes.
In-depth knowledge of hospital and physician contract interpretation, including reimbursement methodologies, contractual compliance, and payment validation.
Skilled in analysing complex claims scenarios, resolving payment issues, and ensuring adherence to payer policies and contractual requirements. 