Telangana Billing specialist Jobs – 63 Open Jobs Today

Senior Executive – Audit Operations
Sagility —Hyderabad
Specialist, OTC
Invesco —Hyderabad, Telangana
- Full-time
- Hybrid work
- Research
- Communication skills
- Health insurance
Eligibility and Benefits Verification Specialist ( US Health care)
DOCTUS DATA SERVICES PVT LTD —Ameerpet, Hyderabad, Telangana
- ₹20,000 - ₹40,000 a month
- Full-time
- Databases
- Analysis skills
- Bachelor's degree
Quick apply
7h
Order Processing and Dispute Resolution Specialist
Heptarc Technology Solution —Hyderabad, Telangana
- Online application
- Oracle
- Salesforce
- Microsoft Office
Accounts Receivable Specialist ( US Health Care)
DOCTUS DATA SERVICES PVT LTD —Hyderabad, Telangana
- Full-time
- Oracle
- Finance
- Bachelor's degree
Quick apply
Insurance Solution Architect
Luxoft —Hyderabad, Telangana
- English
- APIs
- Agile
RCM Operations Support Specialist
ModMed Technologies India Private Limited —Cyberabad, Hyderabad, Telangana
- Full-time
- Bachelor's degree
- Communication skills
- Paid holidays
- Paid sick time
Quick apply
Senior Specialist, Technical Product Management
MSD —Hyderabad, Telangana
- Full-time
- Computer Science
- Project management
- Bachelor's degree
18h
Customer Care -Technical Support Specialist
UWorld, LLC —Hyderabad, Telangana
- Weekend availability
- Windows
- Bachelor's degree
- Data entry
Quick apply
SR TECHNICAL SPECIALIST, APPLICATION DEVELOPMENT – Java HCM
Eximius Tech Innovations —Hyderabad, Telangana
- Java
GN - Industry Consulting - MC - Energy– Consultant
Accenture —Hyderabad, Telangana
- Full-time
- Microsoft Powerpoint
- Microsoft Excel
- Sales
Senior Software Engineer - Mainframe
Chubb —Telangana
- Full-time
- Azure
- Java
- Analysis skills
- Health insurance
- Paid time off
Coding Specialist
Ventra Health, Inc. —Hyderabad, Telangana
- Full-time
- Anatomy knowledge
- Microsoft Excel
- Microsoft Outlook
2d
Test Lead-Guidewire
QualiZeal —Hyderabad, Telangana
- Full-time
- Agile
Process Developer-Order Management
Genpact India Pvt. Ltd. —Hyderabad, Telangana
- Full-time
- Salesforce
- English
- Microsoft Office
Quick apply
CRM SUPPORT
AdyatanTech —Gachibowli, Hyderabad, Telangana
- Full-time
- Azure
- Computer Science
- DevOps
PD - Customer Relations
Genpact India Pvt. Ltd. —Hyderabad, Telangana
- Full-time
- Salesforce
- English
- Microsoft Office
Quick apply
Hospital Billing Assistant Managers (UB04 AMs) 6th Feb- Hyd
Eclat Health Solutions —Hyderabad, Telangana
- Bachelor's degree
- Epic
- Communication skills
Quick apply
Process Associate- Attendance & Workforce Specialist
Harmony United Psychiatric Care —Hyderabad, Telangana
- Full-time
- Microsoft Access
- Bachelor's degree
- Communication skills
- Health insurance
Quick apply
OPT Recruiter / US Talent Acquisition Specialist
Galactix Solutions Pvt Ltd —Cyberabad, Hyderabad, Telangana
- CRM software
- Communication skills
- Negotiation
Quick apply

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Senior Executive – Audit Operations

Sagility -
Hyderabad

Apply Now

Job details

Full job description

About Sagility

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

Job title:

Senior Executive – Audit Operations

Job Description:

The Senior Executive will be responsible for ensuring accurate identification of a clients claim payment anomalies by obtaining the clients provider agreements and contract loading, researching and flagging discrepancies, and validating claims for payment integrity. This role involves collaborating with various departments, using system tools to load contracts, identify claim anomalies, and ensure compliance with healthcare regulations and company policies. The specialist will play a key role in ensuring claims anomalies are accurately and efficiently identified and submitted to the client for recovery of the overpaid claims.

Key Area of Responsibilities:

Contract Loading & Maintenance:

Accurately load, configure, and maintain healthcare provider contracts within the audit and claims systems, ensuring alignment with contractual terms.
Review and update contract details including fee schedules, reimbursement rates, and payment terms to support accurate claims adjudication.
Ensure timely and precise updates to contract data, reflecting the most current agreement terms and minimizing payment discrepancies.

Claims Flagging:

Review claims flagged by the audit system as potentially overpaid to confirm validity and ensure they meet overpayment criteria.
Validate the allowed claim amount against independent sources outside of both the client and Sagility to ensure objective verification.
Identify and flag claims that appear non-compliant with contract terms, benefit rules, or established payment policies.
Investigate potential billing errors or coding discrepancies that may contribute to inaccurate payments.

Contractual Claims Audit & Contract Load Validation:

Review paid claims for accuracy and identify confirmed overpayments, minimizing false positives through thorough validation protocols.
Support quality audit efforts by refining claim review criteria and contributing to process improvements that enhance the accuracy of flagged claims.
Actively work to reduce false positives and improve the true positivity rate of flagged claims by applying data-driven insights and validation best practices.

Data Analysis & Reporting:

Assist the team to identify areas for new audit opportunities as well as areas for further automation or operational efficiency
Generate reports on flagged claims, underpayments, overpayments, and any trends or issues related to payment integrity.
Analyze data to detect patterns of claims issues, providing actionable insights to improve payment accuracy and integrity.
Assist in audits and investigations related to payment integrity.

Collaboration & Communication:

Collaborate with cross-functional teams, including Provider Services, Claims Adjudication, and IT, to resolve payment integrity issues.
Communicate effectively with providers, healthcare professionals, and other stakeholders regarding contract terms and payment issues.

Compliance & Quality Assurance:

Ensure compliance with applicable healthcare regulations, contract terms, and company policies in all payment integrity activities.
Stay updated on industry regulations, payment integrity best practices, and any changes to contract management processes.

Education & Experience:

Graduation or equivalent (required).
4+ years of experience in healthcare and claims adjudication.
2+ years of experience in Prepay/Post-pay Payment Integrity, Data Mining or Contract Audit
Knowledge of healthcare reimbursement systems, payer-provider contracts, and claims adjudication processes is a plus.

Skills & Competencies:

Strong understanding of contract rate loading and healthcare payment processing systems, with the ability to interpret and apply complex provider agreements.
Highly detail-oriented with strong analytical and problem-solving capabilities, especially in identifying payment discrepancies and root causes.
Proficient in Microsoft Office Suite, particularly Excel (e.g., pivot tables, formulas, VLOOKUP), along with Word and Outlook for documentation and communication.
Hands-on experience with healthcare claims platforms such as Facets, TriZetto, or similar systems used in US healthcare operations.
Excellent verbal and written communication skills, enabling effective collaboration with internal teams and external stakeholders.

Strong organizational and time management skills, with the ability to handle multiple priorities and meet tight deadlines in a dynamic environment

Location:

BangaloreIndia

Apply Now

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billing specialist jobs in telangana

Senior Executive – Audit Operations

Specialist, OTC

Eligibility and Benefits Verification Specialist ( US Health care)

Order Processing and Dispute Resolution Specialist

Accounts Receivable Specialist ( US Health Care)

Insurance Solution Architect

RCM Operations Support Specialist

Senior Specialist, Technical Product Management

Customer Care -Technical Support Specialist

SR TECHNICAL SPECIALIST, APPLICATION DEVELOPMENT – Java HCM

GN - Industry Consulting - MC - Energy– Consultant

Senior Software Engineer - Mainframe

Coding Specialist

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CRM SUPPORT

PD - Customer Relations

Hospital Billing Assistant Managers (UB04 AMs) 6th Feb- Hyd

Process Associate- Attendance & Workforce Specialist

OPT Recruiter / US Talent Acquisition Specialist

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