Gnm Staff Nurse

Achievers Spot; Bengaluru; On-site; INR 180,000 - 300,000; Full time

Job summary

Achievers Spot is seeking a Medical Coding professional in Bengaluru who can review health service utilization, coordinate with reviewers, and communicate clearly with clients. Fresh graduates with strong English skills are encouraged to apply.

The role requires attention to detail, the ability to work in fast-paced environments, and adherence to URAC and client guidelines. Training will cover medical management procedures and review processes.

Qualifications

• Diploma or degree in any field is acceptable.
• Fresh graduates with excellent English communication are welcome.
• Strong attention to detail and ability to deliver high-quality work.
• Must be goal-oriented and thrive in fast-paced settings.
• Identify cases eligible for medical reviews and assign to reviewers.
• Communicate with clients to resolve issues identified in cases.

Responsibilities

• Identify cases eligible for medical reviews and assign to reviewers.
• Contact clients regarding problems identified in cases for review.
• Follow URAC, state and client best practices and timeframes.
• Perform medical review assessments on utilization of health services.
• Coordinate reviewer referrals and track case status.
• Support management in developing utilization management programs.
• Handle inbound calls relating to medical reviews and follow established protocols.
• Learn new methods and services as required.

Skills

English communication

Attention to detail

Quality focus

Goal oriented

Education

Diploma/degree in any field

Job description

Job Description

Medical Coding is the Fastest-growing Profession in the Healthcare Industry Today. It is a Niche Specialization and the Demand for Trained and Certified Medical Coders is Increasing Exponentially and Bound to Increase in Upcoming Years, Especially in India.

Job Description

Medical Coding is the Fastest-growing Profession in the Healthcare Industry Today. It is a Niche Specialization and the Demand for Trained and Certified Medical Coders is Increasing Exponentially and Bound to Increase in Upcoming Years, Especially in India.

• you have At Least a Diploma/degree in Any Field.
• this Role is Open to Fresh Graduates with Excellent English Communication Skills.
• you Pay Strong Attention to Details and are Capable of Delivering Top-quality Work
• you are Goal-oriented and Thrive in Fast-paced Environments
• Identify cases eligible for medical reviews and assign these to appropriate reviewers.
• Reach out to the client for any problems identified in the cases for review.
• Adhere to Utilization Review Accreditation Commission (URAC), jurisdictional, and/or established MediCall best practice UM time frames, as appropriate.
• Adhere to federal, state, URAC, client, and established MediCall best practice WCUM time frames, as appropriate.
• Develop a complete understanding of the Medical management Procedures.
• Perform medical review assessment (MRA) on utilization of health services (eg healthcare plans, workers compensation products etc) in an accurate, efficient and timely manner while ensuring compliance with utilization management regulations and adherence to state and federal mandates.
• Provide succinct negotiable points based on the submitted medical records that identify necessary medical treatment, casually related care, response or lack of response to treatment, etc.
• Identify missing records and information that are necessary in the completion of the medical review assessment.
• Adhere to Department of Labor, state and company timeframe requirements.
• Coordinates physician reviewer referral as needed and follows up timely to obtain and deliver those results.
• Track status of all utilization management reviews in progress and follow up on all pending cases.
• Work closely with management team in the ongoing development and implementation of utilization management programs.
• Respond to inbound telephone calls pertaining to medical reviews in a timely manner, following client a established protocols.
• Process customer calls consistent with program specified strategies and customer satisfaction measurements to include but not limited to proper answering procedure, eg opening and closing remarks.
• Learn new methods and services as the job requires.

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HR BHAVANI

9566284629