Executive - Claims Audit

EXL Talent Acquisition Team; Chennai; On-site; INR 558,000 - 1,004,000; Full time

Job summary

EXL Talent Acquisition Team in Chennai is seeking specialists to review and analyze medical records and claims for accuracy, completeness, and regulatory compliance. You will verify documentation supports submissions and medical necessity, and collaborate with providers and billing staff to gather information.

The role requires identifying data gaps, prioritizing workloads to meet timelines, and supporting audits with detailed documentation and analytics.

Responsibilities

• Review and analyze medical records and claims for accuracy, completeness, and compliance with healthcare regulations.
• Verify that all necessary clinical documentation supports claim submissions and medical necessity.
• Identify and resolve inconsistencies, errors, or missing documentation in patient records or claims.
• Prioritize and manage workloads to ensure high-priority claims are processed within defined timelines.
• Collaborate with providers, coders, and billing staff to obtain or clarify needed information.
• Ensure compliance with HIPAA, CMS and other guidelines for medical records and claims processing.
• Prepare reports and summaries of claim findings, trends, and potential process improvements.
• Support internal audits and QA initiatives by providing detailed documentation and analytics.
• Maintain knowledge of healthcare terminology and coding standards (ICD, CPT, HCPCS) and claims procedures.

Job description

Job description:

• 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.