Claim Examiner in Hyderabad

Opportunity Overview: We are seeking a versatile and highly skilled Claims Auditor to join our dynamic Payment Integrity team. This critical role involves conducting comprehensive professional and facility coding reviews—encompassing both outpatient/professional and inpatient claims—to ensure the accuracy of code assignment, DRG/reimbursement, and to maximize overpayment identification. If you possess a CPC and/or CCS credential, expert knowledge of CPT, HCPCS, and ICD-10-CM/PCS coding guidelines, and a passion for deep analytical auditing, you will be instrumental in supporting our commitment to accurate reimbursement solutions. This opportunity requires a self-motivated individual who thrives on precision, compliance, and continuous learning in a high-growth environment What you’ll do: Conduct comprehensive coding reviews to ensure accuracy in code assignment and reimbursement. Conduct comprehensive outpatient and professional coding reviews to ensure accuracy in code assignment and reimbursement. Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. Conduct ambulatory surgery center, emergency room, observation and infusion coding reviews. Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations. Utilize advanced DRG encoder tools (such as 3M, Webstrat) to drive efficiency and accuracy in audits. Meet or exceed company quality and productivity standards, including strong uphold rates for appeals. Stay ahead of industry trends, coding updates, and compliance regulations to maintain expert-level knowledge. Adhere to HIPAA and company policies and procedures to ensure data security and regulatory compliance. Maintain and apply superior knowledge of changes and updates to coding guidelines, reimbursement trends, and

Opportunity Overview: We are seeking a versatile and highly skilled Lead Claims Auditor to join our dynamic Payment Integrity team. This critical role involves conducting comprehensive professional and facility coding reviews—encompassing both outpatient/professional and inpatient claims—to ensure the accuracy of code assignment, DRG/reimbursement, and to maximize overpayment identification. If you possess a CPC and/or CCS credential, expert knowledge of CPT, HCPCS, and ICD-10-CM/PCS coding guidelines, and a passion for deep analytical auditing, you will be instrumental in supporting our commitment to accurate reimbursement solutions. This opportunity requires a self-motivated individual who thrives on precision, compliance, and continuous learning in a high-growth environment What you’ll do: Conduct comprehensive coding reviews to ensure accuracy in code assignment and reimbursement. Conduct comprehensive outpatient and professional coding reviews to ensure accuracy in code assignment and reimbursement. Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. Conduct ambulatory surgery center, emergency room, observation and infusion coding reviews. Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations. Utilize advanced DRG encoder tools (such as 3M, Webstrat) to drive efficiency and accuracy in audits. Meet or exceed company quality and productivity standards, including strong uphold rates for appeals. Stay ahead of industry trends, coding updates, and compliance regulations to maintain expert-level knowledge. Adhere to HIPAA and company policies and procedures to ensure data security and regulatory compliance. Maintain and apply superior knowledge of changes and updates to coding guidelines, reimbursement trends,

Opportunity Overview: We are seeking a Healthcare Analytics Analyst to join our Analytics team. In this role, you will conduct analyses that drive our strategy, inform product performance, and provide insights critical to the development of new clinical intervention strategies and product enhancements. You'll partner closely with cross-functional teams and clients to optimize auto-decisioning performance and deliver increased value. This is an opportunity to directly impact company growth and assist patients at a critical time in their healthcare journey. What you'll do: Research, build, execute and optimize auto-decisioning strategy for new client implementations Work with multiple types of healthcare data to build and maintain analytical and reporting solutions to support strategy and program decision making Identify optimization opportunities based on analyses to improve auto-decisioning performance and drive increased value for clients Perform quantitative analysis of health care cost, operational performance and clinical outcomes using claims and authorization data Track cost, utilization and industry trends to inform stakeholders of solution performance and provide insights around opportunities to optimize clinical value for patients, providers and payers Prepare information for clients, build reports, data visualization and self-service solutions for internal and external stakeholders Develop, review, and analyze detailed data sets leveraged for client reporting/analytics Collaborate with IPA team on rule refinement and metric tracking What you'll need: Must-haves 2-5 years in an analyst role, ideally at a health tech company, health plan, or healthcare consulting firm Has worked hands-on with claims data, authorization data, or utilization management data Proficient in SQL (daily use) Has built and maintained dashboards in Tableau or PowerBI for internal and external stakeholders Bachelor's degree in Health Informatics, Public Health, Data Analytics, o