Senior Executive-Auditors-Datamining

Job description

**Claims Processing & Adjudication** Review, analyze, and process healthcare claims accurately based on payer rules, policy guidelines, and contractual terms. Perform manual payment determination and allowable calculations without relying on system tools. **Revenue Optimization & Data Mining** Identify gaps, underpayments, and missed revenue opportunities through data analysis and claims review. Support data mining programs by providing insights for revenue realization and process improvement. **Quality & Productivity Management** Ensure all assigned claims inventory is completed within defined TAT while maintaining required quality standards. Prepare and update production, quality, and status reports regularly as per business requirements. **Communication & Coordination** Maintain clear and professional communication with internal teams and stakeholders. Participate actively in meetings, calls, and discussions as required to resolve claim or process-related issues. **Compliance & Process Adherence** Follow all compliance protocols, company policies, and HIPAA guidelines without fail. Ensure data confidentiality and integrity are maintained at all times. **Independence & Initiative** Work independently with minimal supervision, demonstrating accountability and ownership for assigned tasks. Contribute proactively to process improvement and efficiency initiatives.