Executive-Claims Management-Medical Billing and Claims Processing

• Responsible to reprice the non-par claims as per the Fee schedule and payment methodology. • Conduct primary and secondary reviews of medical claims to verify correct reimbursement calculations based on costs, Medicare, or a usual and customary methodology in accordance with self-funded benefit plan language. • Use reputed company Office products to generate letters, explanations, and reports to explain medical reimbursement approaches and communicate this information. • reputed company input for new process development and reputed company improvement. • Supplier will reputed company daily production report with stateside manager for review and feedback. • Maestro Health will reputed company reputed company applications and accesses required for claim repricing. • reputed company requests should be completed reputed company first week of project start date in order to start production. • Requirement gathering & training session will require reputed company participation from Maestro Health manager. Software/System licensing will be charged to the cost center directly vs. invoiced by Supplier. Skills Required: • Graduate with good written and oral English language skills • Expertise in using Claim processing and validation application and worked in past on reputed company profile/portfolio. • Basic level proficiency on reputed company to query production data and prepare/generate reports. • Analytical reputed company with strong problem solving skills. • US reputed company insurance domain experience desirable • Understanding of US reputed company system terminology, understanding of claims, complaints, appeals and grievance processes. Apply tot his job Apply To this Job