Cognizant (Nasdaq-100: CTSH) is one of the world’s leading professional services companies, transforming clients’ business, operating and technology models for the digital era. Our unique industry-based, consultative approach helps clients envision, build and run more innovative and efficient businesses. Headquartered in the U.S., Cognizant is ranked 185 on the Fortune 500 and is consistently listed among the most admired companies in the world. Learn how Cognizant helps clients lead with digital at www.cognizant.com or follow us @Cognizant.
- Ensures updating the Issue trackers on a daily basis and timely sharing of agenda prior to client calls
- Performs root cause analysis of claims/encounters processing and submission issues; develops recommendations based on data and industry standards.
- Develops various encounter related reports (Weekly/Monthly outstanding encounter logs)
- Communicates with and provides clear, detailed, effective documentation to other departments within the organization on issues causing encounter pends/denials and potential solutions.
- Collaborates with the Health Plans or Product teams on any encounter related issues
- Identifies and interprets encounter data, submission requirements and performance metrics per the regulatory and health plan guidelines.
- Collaborates across various departments to design and implement any business process and/or systems changes to meet encounter data processing and submission goals.
- Responsible for documenting, monitoring and analyzing the end-to-end encounter life cycle, inbound and outbound encounter process.
- Communicates regularly with supervisors on issues discovered through research efforts
- Owns and maintains the desktop procedures, workflows and policy and procedure documents for encounters
- Researches and documents all encounter errors in established systems(s)/database(s) with appropriate statistical and trend analysis
- Must have a high level of self-motivation and with little guidance/supervision.
- Ability to work under pressure, adhere to deadlines and know when to escalate information/issues.
- Must have outstanding verbal and written communications skills with the ability to communicate clearly to all levels of an organization.
- Candidate should be okay working in night shifts.
- Experience with multiple health plan operation functional areas. Knowledge of Medicare, Medicaid, TPA business requirements is a plus.
- Must have excellent time management and organizational skills with the ability to handle multiple tasks in a timely and accurate manner.
- Must be able to work both independently as well as a team participant.
- Excellent data manipulation, communication, analytical and statistical skills are required.
- Must be comfortable with SQL, MS Excel.
Qualification & Experience:
- 3-5 years working in the health payer industry with proficient level understanding of general business practices and health plan operations (Membership, Provider, Claims, Customer Service, Care Management, etc.) required.
- Experience working with ANSI x12 EDI standards for health care required. Solid analytical skills with ability to compile data from many sources and formulate plans and recommendations.
- Must have strong interpersonal skills. Three (3) plus years health plan operations analysis or related work preferred
Vacancy Type: Full Time
Job Location: Noida, Uttar Pradesh,IN
Application Deadline: N/A