Process Consultant (Quality Audit)
Associate-PC3 (AI-Account Installation team) Quality auditor -US Healthcare Process.Roles and Responsibilities:We worked under Humana Health care Insurance policy.Configuration of client payment system - METAVANCE with numerous health plans in all lines of business - HMO, PPO, POS, Indemnity, HDHP, Individual plans & also self funded plansDeep understanding of Federal Laws (Mandates) of Insurance for various states, rigorous sessions of product analysis in understanding plan limits, re-imbursements, penalties, payment methodologies as part of benefits set-up, are core activities.Understanding of CPT, HCPCS and ICD-CM Codes.Once the customer data has been validated, using knowledge of health care benefit principles, develops the appropriate benefit configuration detail coverage, benefit allowance.Claims/Benefits testing, migration to Production, Maintenance support, are the steps involved.US Health Insurance Copay/deductible/coinsurance configurationWe will complete audit based on the testing logic.Configured several Benefit plans with 'zero' defects/errors.Developing the health insurance entirely from top to bottom using applications - Applications handling: Citrix, SharePoint, Metavance, Humana (plan designer), MS Office (Word, Excel, PowerPoint, outlook).Facilitating regular team meetings/huddles.
