Cognizant Technology Solutions India Pvt Ltd – Process Specialist

Not Applicable

Qualification:
Graduate (exclusion:
BE/BTech/MCA For Medical Management College/ University degree holder.
For NA High School/Equiv, Associates Degree preferred or equiv work experience.

Responsibility:
‘Business / Customer:

Data Processes:

For NA, Claims, RCM, Provider Services and Member Services: Focus on enabling quality deliverables and enhancing customer satisfaction.
Provide regular and meaningful updates and communicates to client, stakeholders and Team lead/management.
Interact with customers (internal / external) to meet process deliverables.
Manage and resolve escalations and issues raised by customers.
Single point of contact for all knowledge related issues.

For Claims, RCM and Provider Services: Data accuracy with respect to client requirements.
All required data to complete the provider database or provider profile needs to be captured with 100% accuracy in the client applications.
Need to work on complex state mandate applications, where the timelines are very stringent.
Minimize rework by developing First Time Right culture.
Generate process improvement ideas for better productivity, accuracy & turnaround time.
Participate as potential seed resources for staffing new engagements.
Perform root cause analysis on the errors made by the team members.
Handles Supervisor Calls and escalation calls.

For Medical Management and Provider Services: Check and update all missing information from the requests as required by customer/client.
Monitor product updates and communicate product inquiries with the client.

Query Management:Ensure minimum transactions are routed to the client and all procedural queries are handled in-house

For NA: Report performance dashboards on a periodic basis to the customer stakeholders.
Engage with Customer and drive status report meetings.

Voice Processes:

For Claims, RCM and Member Services: Effectively communicate information on products/services or trouble shoot issues within the specified time frames as agreed upon with the client,.
In a manner that is understandable by the end user/ customer.
Connect with the customer & provide highest level of customer satisfaction.

Project / Process:

Data Processes:
:
Perform transactions as per defined guidelines.
Resolve process related queries within defined timelines.
Provide periodic status reports to the team leader on performance, status and any escalations.
Adhere to defined support and quality processes as per the guidelines.
Maintain proper documentation of all the transactions.
Perform quality assurance review wherever applicable basis the process requirement.
Assist with audits and maintain strict level of confidentiality on all matters pertaining to provider and /or payers.
Prepare professional communication, emails, letters to providers.
Meet deadlines and ensure good follow in call and email tracking.
Ensure that quality, efficiency and productivity standards and targets are met.
Review productivity with each associate and recommends followup training if necessary.
Analyze areas for improvement with an objective to meet program metrics.
Report regular error feedback.
Performs other duties as may be assigned.
Focus on enabling quality deliverables and enhancing customer satisfaction.
Provide regular and meaningful updates and communicates to client, stakeholders and Team lead/management.
Participate as potential seed resources for staffing new engagements.
Perform root cause analysis on the errors made by the team members.
Minimize rework by developing First Time Right culture.
Identify knowledge gaps and provides inputs to the training teams.
Act as Internal Auditor for the process auditing the domainspecific metric.
Take Initiatives to improve quality rankings and completing assignments on time.
Respond to queries raised by the team and provide appropriate feedbacks.
Participate in project and organization initiatives led by the Delivery leadership.
Contribute new ideas and innovative approaches at work.

For Medical Management: Assist the associates in performing their tasks as per client, state and/or federal protocols as well as other related guidelines.
Ensures that associates are informed and updated on changes in state rules, regulations and client protocols.
Under the direction Team Lead/Team Manager, act as a resource person for specific regulations and protocols, to properly address issues and concerns on medical review process.
Act as frontline in providing product updates and answering process related questions from process executives and senior process executives.
Take charge of the operations in the absence Team Lead / Team Manager.
Maintain acceptable levels of performance including but not limited to attendance, adherence, customer courtesy, and all other productivity and efficiency targets and objective.
Monitor compliance of associates to established federal, state, URAC, client and protocols.
Keep track of turnaround time of specific state reviews and coordinates with the process executives and senior process executives to facilitate release of medical review assessments on time.
Report to the Team Lead/ Supervisor/ Manager on state review statistics, issues encountered complaints, etc and escalate unresolved issues as appropriate.
Oversee the work of new hires and continuous coaching of the programs staff with the assistance of the Team Lead.
Complete a QC report and coach Nurse Reviewer/s regarding corrections and/or suggestions made in their review.
Work closely with the Program Trainer in establishing and maintaining Program Manuals.

For Claims: Active participation in the process/knowledge transitions from business to Cognizant center.
Successful client certification as Process trainer (offshore) and subsequent Offshore knowledge transfer.
Responsible for review and updation of domain specifics SPOC for all queries before it is put forward to the client and create a repository of FAQs.
Ensure any updates in state mandates, policy & procedures would reach the operations team in a timely fashion.
Assist associates in processing tricky and high value transactions.
Deliver and validate clientspecific metric deliverables.
Responsible for claims adjudicated in a day.
Adjudication of claims with zero critical errors Responsible for assisting with online research projects for claim and litigation matters.
Responsible for preparing litigation files for archiving.
Responsible for assisting with collections This includes payment processing, record keeping, correspondence composition, and damage invoice composition.
Work effectively in team environment to coordinate all credentialing processes (ie Third party verification groups wherever applicable basis the process requirement).
Support the floor on queries related to complex Benefit plans and Benefit plan analysis.
Lead the daily huddle related to knowledge management.
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.
Continuous contribution to process excellence/improvement.
Perform task estimation.
guide the service analyst on estimation.

For RCM: ‘ Perform quality assurance review on completed credentialing files.
Responsible for the inventory of the respective hospital accounts and deliver the SLA parameters.
Responsible for the agents working in the respective hospital accounts.
Develop Provider Directory with accurate details of providers.
Collect and verify all demographic information from the provider through different sources as deemed appropriate.
Verify all education & hospital affiliations information of the providers.
Receive and process provider database on a regular basis.
Tracks progress of outstanding verifications from Schools and Hospitals.
Works effectively in.