Job description:
- Review and analyze medical records and claims data to ensure accuracy, completeness, and compliance with healthcare regulations and payer requirements.
- Verify that all necessary clinical documentation is included to support claim submissions and medical necessity.
- Identify and resolve inconsistencies, errors, or missing documentation in patient records or claims.
- Prioritize and manage workloads to ensure expedited and high-priority cases are processed within defined timelines.
- Collaborate with healthcare providers, coders, and billing staff to obtain or clarify necessary information.
- Ensure compliance with HIPAA, CMS, and other regulatory guidelines related to medical record handling and claims processing.
- Prepare accurate reports and summaries of claim findings, trends, and potential process improvements.
- Support internal audits and quality assurance initiatives by providing detailed documentation and analytical insights.
- Maintain a strong understanding of healthcare terminology, coding standards (ICD, CPT, HCPCS), and insurance claim procedures.
Responsibilities:
Complete the necessary training and meet the expectations outlined for the position.
Follow all standard operating procedures (SOP) diligently.
Complete audits promptly and ensure high quality.
Strive to meet both quality and production targets.
Adhere to project protocols and instructions.
Report any issues or trends promptly.
Maintain the logs (such as productivity, clarification, and others as applicable) updated.
Seek clarification from the manager or team leader when needed.
Promptly respond to all emails from the manager.
Ensure compliance with all relevant regulations and policies.
Qualifications
Qualifications: Any Graduate/ Postgraduate
Working Hours: 40 hours /week, Full Time Employee
Work Model: Training from office for 2 - months and hybrid there after
Telecommuter/Internet requirements, if applicable: High Speed internet connection and Power back up
Skills and abilities:
3-5 years of Experience.
Good communication, flexibility, reliability
Knowledge in Microsoft outlook/excel/word/PPT.
Strong Analytical skills with the ability to investigate and resolve issues
Familiarity with HIPAA, Medicare, Medicaid and other payer specific regulations.
Skills Required
- Graduate or Postgraduate degree
- 3-5 years of experience in claims audit/medical records review
- Knowledge of ICD, CPT, HCPCS coding standards
- Familiarity with HIPAA, Medicare, Medicaid, and payer regulations
- Proficiency with Microsoft Outlook, Excel, Word, PowerPoint
- Strong analytical skills with ability to investigate and resolve issues
- Good communication, flexibility, and reliability
- High-speed internet connection and power backup (for hybrid/remote work)
What We Do
Choosing a digital partner is about more than capabilities — it’s about collaboration and character. Unrealistic overhauls and off-the-shelf products ignore what matters most — your unique needs, culture, goals, and your legacy data and technology environments. At EXL, our collaboration is built on ongoing listening and learning to adapt our methodologies. We’re your business evolution partner—tailoring solutions that make the most of data to make better business decisions and drive more intelligence into your increasingly digital operations. Whether your goals are scaling the use of AI and digital, redesign operating models, or driving better and faster decisions, we’re here to partner with you to help you gain—and maintain—competitive advantage with efficient, sustainable models at scale. Our expertise in transformation, data science, and change management helps make your business more efficient and effective, improve customer relationships and enhance revenue growth. Instead of focusing on multi-year, resource- and time-intensive platform designs or migrations, we look deeper at your entire value chain to integrate strategies with impact. We use our specialization in analytics, digital interventions, and operations management—alongside deep industry expertise — to deliver solutions that help you outperform the competition. At EXL, it’s all about outcomes—your outcomes—and delivering success on your terms. Share your goals with us and together, we’ll optimize how you leverage data to drive your business forward. For more information, visit www.exlservice.com.
