Pricing Manager

EXL Talent Acquisition Team; Dadri; On-site; INR 1,200,000 - 2,200,000; Full time

Job summary

EXL Talent Acquisition Team in Noida is seeking a Financial Planning & Analysis - Pricing & Commercials professional with 6-9 years of experience. A Bachelor’s degree in a relevant field is required to support pricing and commercial decisions for the business.

The role involves working with Regional Medical Directors to make evidence-based clinical decisions regarding requested cases, and performing retrospective clinical reviews in line with CMS guidelines, including outbound provider outreach

Qualifications

• Bachelor Degree in relevant field.
• 6-8 years of relevant experience.

Responsibilities

• Performs clinical review of cases received from the specialist team or other departments within CCR.
• Determines if additional clinical information is required and makes a clinical decision to approve or deny a case based on plan coverage, criteria and guidelines.
• Coordinates a peer to peer (doctor to doctor case discussion) review as applicable.

Education

Bachelor Degree in relevant field

Job description

• Job Role Financial Planning & Analysis-Pricing & Commercials
• Experience (In Years) 6-9
• Job Location Noida

Job Description

Works with Regional Medical Directors to make sound, evidence based clinical decisions regarding the requested cases (treatments and procedures) for IP/OP and performs retrospective clinical reviews utilizing criteria set forth by the client and Medicare (CMS-Centers for Medicare and Medicaid Services) and perform outbound calls to providers.

Responsibilities

Performs clinical review of cases received from the specialist team or other departments within CCR, determines if additional clinical information if required, makes a clinical decision to approve or deny a case based on plan coverage, criteria and / or guidelines or pend / refer it to the Regional Medical Directors for further review for medical necessity, and coordinates a peer to peer (doctor to doctor case discussion) review as applicable.

Qualifications

Bachelor Degree in relevant field with 6- 8 years of relevant experience