Manager leading product portfolio team to enable technology solutions aligned with business goals at Navy Federal. Fostering cross - functional collaboration in an agile environment.
About the role
- Assistant Manager - Claims Audit role focused on reviewing claims for accuracy and compliance. Working at EXL, a leading data analytics and operations company in the healthcare sector.
Responsibilities
- Review and analyze medical records and claims data to ensure accuracy, completeness, and compliance with healthcare regulations and payer requirements.
- Verify that all necessary clinical documentation is included to support claim submissions and medical necessity.
- Identify and resolve inconsistencies, errors, or missing documentation in patient records or claims.
- Prioritize and manage workloads to ensure expedited and high-priority cases are processed within defined timelines.
- Collaborate with healthcare providers, coders, and billing staff to obtain or clarify necessary information.
- Ensure compliance with HIPAA, CMS, and other regulatory guidelines related to medical record handling and claims processing.
- Prepare accurate reports and summaries of claim findings, trends, and potential process improvements.
- Support internal audits and quality assurance initiatives by providing detailed documentation and analytical insights.
- Maintain a strong understanding of healthcare terminology, coding standards (ICD, CPT, HCPCS), and insurance claim procedures.
Requirements
- Any Graduate/ Postgraduate
- 4-6 years of Experience
- Good communication, flexibility, reliability
- Knowledge in Microsoft outlook/excel/word/PPT
- Strong Analytical skills with the ability to investigate and resolve issues
- Familiarity with HIPAA, Medicare, Medicaid and other payer specific regulations.
Benefits
- Working Hours: 40 hours /week, Full Time Employee
- Work Model: Training from office for 2 - months and hybrid there after
- Telecommuter/Internet requirements: High Speed internet connection and Power back up
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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