Associate III – BPM

  Medical Coding

Job title: Associate III – BPM

Company: UST Global

Job description: Job Description:

Role Proficiency:

A Voice Associate Able to independently take customer support calls effectively and efficiently ;follow the SOPs to complete the process and endeavour to resolve the issue handle some escalated issues or escalate to a more knowledgeable person to resolve in alignment with SLAs and assists Lead I – BPM.rnA Data Associate should independently be able to effectively and efficiently process the transactions assigned in timely manner clarify complex transactions to others and ensure that quality of output and accuracy of information is maintained in alignment with SLAs and assists Lead I – BPM.


Measures of Outcomes: * 100% Adherence to quality standards

  • Adherence to turnaround time for response and resolution
  • Completion of all mandatory training requirements
  • 100% adherence to process and standards
  • 100% adherence to SLAs where applicable
  • Number of issues fixed/tasks completed
  • Number of non-compliance issues with respect to SOP
  • Zero/No Client Escalations
  • Number of high-quality RCA and QA output
  • Daily/weekly performance reporting
  • Mentors A1 and A2 resources on the processes

Outputs Expected:

Processing Data: * Processing transactions assigned as per SOPs

Handling calls Voice: * Handle customer support calls resolve issues and complete after-call work

Production: * Take calls (voice) or process complex transactions (data)

Issue Resolution: * Address any problems with the supervisor/QA to ensure maximum productivity and efficiency.

  • Identifies analyses and solves the incidents/transactions.

Productivity: * Proficient in the process assisting other team members who are new to the process as well to ensure quick readiness of the team.

  • Take steps to improve performance based on coaching.
  • Production readiness of new joiners within agreed timeline by providing guidance Actively participate in the team’s or organization wide initiatives
  • Able to handle and manage higher complexity tasks.

Adherence: * Be aware of any clients process or product updates and ensure 100% compliance towards the same.

  • Adhere to release management process.
  • Thorough understanding of organization and customer defined process. Consult with mentor when in doubt.
  • Adherence to defined processes.
  • Adhere to organization’ s policies and business conduct.

Reporting: * Create reports on specific SLAs/performance measures/KPIs

Stakeholder Management: * Guide the team in preparing status updates and keep management updated about the status.

Training : * Attends one on one need-based domain/project/technical trainings as needed.

  • On time completion of all mandatory training requirements of organization and customer.
  • Provide on floor training and one to one mentorship for new joiners.

Escalation: * Escalate problems to appropriate individuals/support team based on established guidelines and procedures.

Monitoring: * Monitor progress of requests for support and ensures users and other interested parties are kept informed.

Manage knowledge: * Consume project related documents share point libraries and client universities

Mentoring: * Mentor and provide guidance to peers and junior associates.

  • Assist new team members in understanding the customer environment.

Communication: * Status update to the respective stakeholders and within the team

Collaboration: * Collaborate with different towers of delivery for quick resolution (within SLA); document learning’s for self-reference.

  • Collaborate with other team members for timely resolution of errors.

Skill Examples: * Customer Focus: Focus on providing a prompt and efficient service to customers goes out of the way to ensure that individual customer needs are met.

  • Attention to detail to ensure SOPs are followed and mistakes are not knowingly made
  • Team Work: Respect others and work well within the team.
  • Communication: Speak clearly and write in a clear and concise manner. Uses appropriate style and language for communication (Data)
  • Communication: Speaks in an accent neutral manner or with the accent required for the process with good vocabulary and grammar skills. Writes clearly (Voice)
  • Typing Speed with 15WPM and 80% accuracy
  • Analytical approach: Makes systematic judgments based on information and relevant assumptions.
  • Ability to follow SOP documents and escalate the alerts within the defined SLA Willingness and ability to learn new skills domain knowledge etc.
  • Make rule based and discretionary decisions.
  • Process Trainer/Sr. QA/Domain Expert/MIS Analyst
  • Frontline resource – Voice/Backoffice Quality Auditors SME Domain Experts

Knowledge Examples:

Knowledge Examples * Expertise with Windows Operating Systems MS Office tools

  • English comprehension – Reading writing and speaking
  • Domain knowledge based on process (healthcare banking investment F&A retail customer support etc)
  • Familiarity with work allocation and intake functions
  • Familiarity with quality control processes including pare to analysis and root cause analysis
  • Knowledge on security policies and tools
  • Good understanding of customer infrastructure ability to co-relate failures
  • Experience level – 3 to 7 years

Additional Comments:

Sr. Claims Processor Job Description: Reporting to the Claims Supervisor, the Claims Adjuster will make revisions to previously processed healthcare claims based on identified processing errors, additional medical record documentation and or other party liability information that changes the conditions of the claim. Responsibilities: • Examine claim forms and other records to determine insurance and benefit coverage, pricing and member liability. • Review medical record documentation, authorization information and member benefit coverage to determine the extent of liability for payment. • Request medical records from providers or other parties involved if needed or indicated. • Review claim disputes submitted by member and providers. • Manually adjust a claim that was originally processed incorrectly. • Use software to adjust batches of claims requiring similar types of adjustments. • Follow corporate and customer claims processing and claims adjustments guidelines, policies and procedures to determine the correct way to adjust and or revise claims. • Ensure that all procedures are carefully followed to document clean claim receipt date and follow guidelines for documenting reasons for claim adjustments. • Consult with auditors, Leads and Subject Matter Experts on complex claims. • Maintain skills in claims adjustments, medical coding and CMS claims processing guidelines by completing continuing education and claims training. Skillset: • High school degree required; Bachelor’s degree preferred with three (3) plus years of relevant professional experience in Healthcare claims operations for a large national/regional or Blues health plan or insurance company and/or TPA. • Previous Claims Adjuster experience. • Knowledge of physician practice and hospital coding, billing and medical terminology, CPT, HCPCS, ICD-9 and ICD-10. • Experience with UB/Institutional (UB04); Professional (CMS1500) claims and HIPAA-compliant EDI formats for claims related exchanges. Understand CMS guidelines for claims processing. • Strong experience in the analysis and processing of claims, utilization review/quality assurance procedures, CMS payment methodologies (i.e. Medicare Physician Fee Schedule, DRGs, Anesthesia, etc.) • Must be able to work with minimal supervision. • Creative thinker with good problem resolution skills related to the healthcare claim adjudication. • Strong experience on how to review what services have been Authorized by Utilization Review. • Maintain a full comprehensive understanding of the covered benefits, coding and reimbursement policies and contracts. • Self-starter who is highly motivated to get the job done. • Excellent verbal and written communication skills. • Proficiency with MS Office applications, especially Word and Excel.

Expected salary:

Location: Chennai, Tamil Nadu

Job date: Fri, 15 Jul 2022 01:55:47 GMT

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