Executive - Claims Audit

Ex; Chennai; On-site; INR 500,000 - 750,000; Full time

Job summary

Ex is seeking a healthcare data professional to review and analyze medical records and claims data for accuracy, completeness, and regulatory compliance. You will verify documentation to support submissions and medical necessity, resolving discrepancies and ensuring timely processing.

Collaboration with providers, coders, and billing staff will be essential to obtain or clarify information. You will contribute to audits and quality initiatives, maintaining strong knowledge of ICD, CPT, HCPCS

Qualifications

• Review and analyze medical records and claims data for accuracy, completeness and regulatory compliance.
• Verify that all necessary clinical documentation supports claim submissions and medical necessity.
• Identify and resolve inconsistencies, errors, or missing documentation in records or claims.
• Prioritize and manage workloads to meet defined timelines.
• Collaborate with providers, coders, and billing staff to obtain or clarify information.
• Ensure compliance with HIPAA, CMS and other guidelines related to medical record handling.
• Prepare accurate reports and summaries of claim findings, trends, and improvements.
• Support internal audits and quality assurance with documentation and insights.
• Maintain understanding of coding standards (ICD, CPT, HCPCS) and insurance claim procedures.

Responsibilities

• Review and analyze records to ensure accuracy and regulatory compliance.
• Coordinate with healthcare providers to obtain needed information.
• Identify gaps and discrepancies and implement corrective actions.
• Prepare reports on claim findings and process improvement opportunities.

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.