Cognizant Technology Solutions India Ltd Chennai Senior Process Executive Posts | B.E/B.Tech/MCA | Apply Now
Cognizant Technology Solutions India Ltd is a leading provider of information technology, consulting, and business process services, dedicated to helping the world's leading companies build stronger businesses.
In the latest job announcement, Cognizant careers India announces job vacancies for Senior Process Executive posts, with work location in Chennai.
Under Cognizant Chennai Hiring Senior Process Executive 2021 Jobs, candidates having required skills in Medical Coding, Medical Management can apply.
The selected candidate will be recruited with a permanent and full-time job.
An Interested and qualified candidate has to apply through online mode.
Job Designation: Senior Process Executive-Data.
Job Code: 00045463863.
Education Qualification: B.E/B.Tech/MCA.
Experience Level: 2 to 4 years.
Job Location: Chennai.
Apply Mode: Online.
- Efficiently Process a predefined number of transactions as assigned with the highest level of accuracy as agreed upon by the client.
- Provide the highest level of customer satisfaction.
- Strive to understand and resolve issues/queries at the first instant.
- Maintain the business controls as per the requirement.
- Articulate/ communicate in a manner that is understood by clients/end users.
- Connect & provide the highest level of satisfaction to the customer.
For Member Management:
- Generate client-specified reports relating to operations.
- Respond to data requests and other inquiries from the client.
- Release WCUM determinations to claim stakeholders following client-established protocols.
- Identify the medical flags in the client system.
- Provide reports and other data requests specified by the client.
- Serve as first-level contact for customer complaint resolution.
- Provide reports and other data requests specified by the client.
Take ownership of delivery including any customer communication and handle queries/clarifications from the customer.
- For Claims, RCM, Provider Services and Member Services:
- Make and Answer calls to and from customers/end users based on agreed time frames.
- Transfer calls involving next level of service to the appropriate department as per the given guidelines.
Project / Process:
- Ensure to meet all Statistical, Financial and TAT metrics while processing claims.
- 100% Process adherence to transaction processing timelines involving medical management processes.
- Adhere to audit compliance (Internal, Statutory Audit) of all Healthcare processes as laid out by Cognizant / the client of Cognizant.
- 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 process and team leads.
- Record data relating to production statistics, enduser related notes, etc as appropriate.
- Stay updated with the process knowledge/changes refer to knowledge updates/ repositories to effectively process transactions.
- Adhere to security practices set by the organization.
- Implement small process improvement projects.
- Provide updates and submit reports related to own area of work.
- Resolve process-related queries and expedite on data requests.
- Respond to data requests.
- Maintain confidentiality of all information, policies, and procedures as required by the Health Insurance Portability and Accountability Act (HIPAA) protocols.
- 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.
- Contribute new ideas and innovative approaches at work.
- Participate in project and organization initiatives led by the Delivery leadership.
For Medical Management:
- Identify cases eligible for medical reviews and assign these to appropriate reviewers.
- Reach out to the client for any problems identified in the cases for review.
- Adhere to Utilization Review Accreditation Commission (URAC), jurisdictional, and/or established MediCall best practice UM time frames, as appropriate.
- Adhere to federal, state, URAC, client, and established MediCall best practice WCUM time frames, as appropriate.
- Develop a complete understanding of the Medical management Procedures.
- Perform medical review assessment (MRA) on utilization of health services (eg healthcare plans, workers compensation products etc) in an accurate, efficient and timely manner while ensuring compliance with utilization management regulations and adherence to state and federal mandates.
- Provide succinct negotiable points based on the submitted medical records that identify necessary medical treatment, casually related care, response or lack of response to treatment, etc.
- Identify missing records and information that are necessary in the completion of the medical review assessment.
- Adhere to Department of Labor, state and company timeframe requirements.
- Coordinates physician reviewer referral as needed and follows up timely to obtain and deliver those results.
- Track status of all utilization management reviews in progress and follow up on all pending cases.
- Work closely with the management team in the ongoing development and implementation of utilization management programs.
- Respond to inbound telephone calls pertaining to medical reviews in a timely manner, following client-established protocols.
- Process customer calls consistent with program specified strategies and customer satisfaction measurements to include but not limited to proper answering procedure, eg opening and closing remarks.
- Learn new methods and services as the job requires.
- Advise supervisor of any potential problems as they become evident.
- Manage assigned workload within established performance standards.
- Perform quality control on medical review assessments generated by the medical review process.
- Utilize the approved monitoring tool and updated template completion guidelines as required to compile and track the performance of each associate.
- Provide feedback to the Team Leads and Manager on the performance of each associate and the team as a whole.
- Maintain and secure the confidentiality of Client’s data and all individually identifiable health information accessed through the client’s and/or Cognizant’s systems.
- Coordinates with the immediate superior regarding updates in policies, procedures and process flow, and state requirements.
- Learn new protocols and systems as the job requires.
- Escalate to the immediate superior any unforeseen events or situation beyond assigned tasks and jurisdiction.
- Process Claims documents with zero critical errors and complete claims transaction volumes in queue within the specified TAT.
- Contribute towards creation of knowledge updates & stay updated with process knowledge/changes.
- Advice and counsel employees on benefit-related issues in accordance with the Certified and classified Master Agreements and Administrative Program enabling proper and complete utilization of existing and new benefits.
- Code complex plans in the system after thoroughly analyzing the source documents.
- Benefit Plan analysis where she/he creates the source document for coders by reviewing the master agreement document.
- Follow up on all pending claims appropriately and initiate the next steps.
- Complete transactions for claims submissions, rejections, Payment posting as defined in SOP’s.
- Complete coding transactions with the required ICD, CPT and other requirements.
- Highlight global issues in the respective hospital accounts.
- Cross-training on multiple process.
For Provider Services:
- Work on difficult and complex transactions with stringent turnaround time and specifics are necessary.
- Complete missing information in provider details and update the database accordingly for first time providers and already existing provider groups in the client systems or database.
- Maintain accuracy on data procured during outreach/Fax or Email.
- Validate and update the information into the client/customer systems to remove duplicate /unwanted /expired information.
- Review and analysis of the provider application for completeness and accuracy.
- Verification of data through approved sources listed by the client.
- Data entry of updated/additional information from provider application to client system after due verification.
- Collect all pertinent information from the provider, provider’s malpractice insurer, National Practitioner Data Bank (NPDB) and other sources as listed by the client.
- Make outreaches to providers to collect missing.
Good To Have Skills:
- Medical Coding
- Medical Management
How to apply:
Interested and qualified job applicants have to apply through online mode, by initially registering with Cognizant career portal and login in to apply.