Virupaksha T Lsswb

Quality Review Specialist Sme Process Specialist - Healthcare Claims @Cognizant

Bangalore Urban, IN

Individuals in this role are Subject Matter Experts who process transactions as well as support the team on process knowledge related requirements and activities related to maintaining process documentation. They enable understanding of frameworks through training, drive adherence to process frameworks through audits and update/ maintain knowledge management by performing activities like root cause analysis on the errors made by the team members. Additionally, individuals may also be required to perform review process role in addition to the current role on an as needed basis. • Process specialists support the Team Manager/Program Manager with Process and Quality compliance, certification and process improvement activities. They are the single point of contact for resolving queries internally/ externally. They participate on the review calls with the process owners while playing this role of an individual independent contributor. • Individuals in this role monitor compliance, protocols and regulatory requirements for Utilization management function For Claims- • Individuals in this role are Subject Matter Experts who assist the PE/SPE population in clarifying doubts, working on SOPs, process reengineering, process documentation and updates, refreshers, working on cheat sheets, building knowledge repositories, assisting the training team in putting together training material for the process and so on. They also closely work with the Quality Assurance team on errors and putting together a CAPA (Corrective and Prevention Actions). They would also be engaged by the BD team to help build capability deck and process insight while responding to proposals. For RCM • Expected to transcribe information from a variety of sources into a standardized database system using various applications based on certain pre-defined business rules as per the client (Payer or Provider). • Advisors would require leading, coordinate & participate in various queues as per business requirements.

Bangalore University

Bachelor of Arts - BA, Literature