“Good manners will open doors that the best education cannot“. – Clarence Thomas
Process Executive Data jobs/roles are being offered by Cognizant. 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.
|Job Id/No (if any):||000476926428|
|Designation/Position/Role:||Process Executive Data|
|Qualifications:||Bachelor’s degree in Nursing|
|Year of Passing:||2021/2022|
|Employment/Job Type:||Full Time|
|Years of experience:||0-1 year|
|Work Location:||Coimbatore, Tamil Nadu, India|
|Work Shifts (if any):||Day Job|
|Work Mode (if any):|
|Job posted on:||May 26, 2022|
|Last date to apply (if any):|
|No. of Vacancy (if any):|
|Contact Email (if any):|
|Address (if any):|
Eligibility (Who can Apply):
- For Medical Management Bachelor’s degree in Nursing or any health science-related field
- For NA High School Equiv.
- Bachelor’s degree in Nursing
- Commercial Claims
- Provide the highest level of customer satisfaction.
- Strive to understand and resolve issues/queries in the first instance.
- Maintain the business controls as per the requirement.
For NA, Medical Management and Benefit Coding:
- Respond to data requests and generate client-specified reports in a timely manner.
- Articulate/ communicate in a manner which is understood by clients / end-users.
Claims, RCM and Member Services:
- Efficiently Process a predefined number of claims/enrollment as assigned with the highest level of accuracy as agreed upon by the client.
- Escalating the issues received in different batches.
- Supporting the team to achieve the SLA and TAT associated with Correspondence, Payments, PIA, and Write off.
- Delivering the quality metrics as defined by Customers.
For Claims, RCM and Member Services:
- Make and Answer calls to and from customers/end users based on agreed time frames.
- Transfer calls involving the next level of service to the appropriate department as per the given guidelines.
Project / Process:
- Develop a complete understanding of the Procedures.
- Complete transactions for data preparation, submissions, etc as defined in an SOP.
- 100% Process adherence to transaction processing timelines.
- Adhere to audit compliance ( SAS 70, SOX, Statutory Audit) of all processes laid out in process documentation.
- Ensure process guidelines are followed and met as documented.
- Set productivity /Quality benchmark.
- Adhere to shift handover processes.
- Raise process related issues/concerns on time with the process and team leads.
- Ensure to meet all Statistical, Financial and TAT metrics.
- Stay updated with the process knowledge/changes and refer to knowledge updates/ repositories to effectively process transactions.
- Adhere to security practices set by the organization.
- Provide updates and submit reports related to your own area of work.
- Complete transaction/call volumes in the queue within specified Turn Around Time.
- Respond to data requests.
- Perform administrative duties which include maintaining accurate records of information regarding received claims/treatment requests.
- Record data relating to production statistics, end-user related notes, etc as appropriate.
- Maintain confidentiality of all information, policies, and procedures as required by the Health Insurance Portability and Accountability Act (HIPAA) protocols.
- Raise process related issues/concerns to team leads/managers.
- Adhere to federal, state, URAC, client-specified, and established best practices regarding utilization management.
- Adhere to program quality standards and maintain acceptable levels of performance, including but not limited to attendance, adherence to protocols, customer courtesy, and all other productivity and efficiency targets and objectives.
- Continuous contribution to process excellence/improvement.
- Participate in project and organization initiatives led by the Delivery leadership.
For Medical Management:
- Receive, login and file a variety of reports, client charts, client interactions and other documents as needed in the account.
- Efficiently prepare and/or assign a predefined number of cases/transactions with the highest accuracy.
- Prescreen a claim/treatment request for completeness and determine if this is appropriate for further processing.
- Sort, upload and assign the claim/treatment request to a case administrator, nurse reviewer or physician reviewer.
- Follow up on all pending claims appropriately and initiate the next steps.
- Input enrollment/change data in a timely manner to coincide with transmittal to vendors and district payroll.
- Process claims documents with zero critical errors.
- Manage benefits documentation by assembling benefit packets, and filing benefits paperwork.
- Read and analyse the Benefit Grid/Source document, understand the benefits and code the same in the application.
- Works on Blue Exchange, Benefit Narratives and related lines of businesses.
- Follow up on all pending claims appropriately and initiate the next steps.
- Complete transactions for claims submissions, rejections, and Payment posting as defined in an SOP.
- Complete coding transactions with the required ICD, CPT and other requirements.
- Respond to data requests.
- Process claims, charges and coding with zero critical errors.
For Provider Services:
- Review and analysis of the provider application for completeness and accuracy.
- Perform verification of data through approved sources listed by the client.
- Collect all pertinent information from the provider, provider’s malpractice insurer, National Practitioner Data Bank (NPDB) and other sources as listed by the client.
- Receive and process new and renewal credential applications for a variety of credentials, certificates, Permits and waivers.
- Make outreaches to providers to collect missing/outdated information.
- Manage Inventory and work on files that require multiple follow-ups with the provider.
For Member Services:
- Process enrollment documents with zero critical errors.
- Complete enrollment or disenrollment / query calls transactions within the queue within a specified turnaround time.
- Develops, coordinates, and executes project plans.
People / Team:
- Contribute to and participate proactively in knowledge sharing sessions.
- Completes all mandatory assessments/ certifications as applicable.
- Align individual goals with team objectives (work cohesively with the team).
- Participate and contribute to organizational activities.
- Record own attendance and timesheet related data.
- Builds and maintains a cohesive cross-organization/company project team ethos and fosters productive working relationships, optimally assigning tasks to team members.
- Contribute towards updating knowledge assets, user manual, and online help document.
- Contribute to teams’ Learning and knowledge development programs.
- Apply it.
- They will contact you either by call or by mail.
This content is the property of Cognizant. We have just published it on Query Karo for sharing information for the candidates who need Process Executive Data jobs/roles. We hereby declare that the above-provided information is true and original as per our knowledge and from the source link.
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