HIM Analyst – Payor Platform
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Job Summary
Job Title: HIM Analyst Payor Platform
Location: Kondapur Hyderabad India
Work Mode: Work From Office (5 Days a Week)
Shift Timings: 5:30 PM 2:30 AM IST (Aligned with U.S. Eastern Time)
Employment Type: Full-Time Permanent
Job Summary
We are seeking a Health Information Management (HIM) Analyst with 2 years of experience supporting U.S. Healthcare Payor platforms. The ideal candidate will have experience working with health plans payer operations claims processing member eligibility provider data utilization management and healthcare data management processes.
The candidate will be responsible for maintaining healthcare information accuracy supporting payer workflows ensuring compliance with healthcare regulations and collaborating with cross-functional teams to optimize operational processes.
Key Responsibilities
- Support Health Information Management (HIM) processes within U.S. Healthcare Payor environments.
- Review validate and maintain healthcare data related to members providers claims and authorizations.
- Analyze healthcare records and documentation to ensure data accuracy and compliance.
- Support claims lifecycle processes eligibility verification utilization management and care management workflows.
- Perform data quality audits and identify discrepancies within healthcare systems.
- Collaborate with business users operations teams and technical teams to resolve data and process issues.
- Generate reports dashboards and operational metrics to support business decisions.
- Participate in system testing validation and user acceptance testing (UAT).
- Ensure compliance with HIPAA and healthcare regulatory requirements.
- Document business processes workflows and standard operating procedures.
Requirements
- Bachelors degree in Health Information Management Healthcare Administration Life Sciences Pharmacy Nursing or a related healthcare field.
- Minimum 2 years of experience in HIM Healthcare Operations Payor Platforms Claims Processing Provider Data Management or Member Services.
- Strong understanding of U.S. Healthcare Payor operations.
- Experience with Claims Eligibility Benefits Authorizations Provider Data or Utilization Management processes.
- Knowledge of HIPAA regulations and healthcare compliance standards.
- Strong analytical problem-solving and communication skills.
Mandatory Certification
Candidates must possess at least one of the following certifications:
- RHIA (Registered Health Information Administrator)
- RHIT (Registered Health Information Technician)
- CCS (Certified Coding Specialist)
- CPC (Certified Professional Coder)
- AHIMA Certification
- AAPC Certification
- Certified Professional Medical Auditor (CPMA)
Preferred Skills
- Experience working with U.S. Health Insurance Plans Managed Care Organizations or Payor Platforms.
- Knowledge of ICD-10 CPT HCPCS and healthcare reimbursement processes.
- Experience with healthcare data analysis and reporting.
- Familiarity with Utilization Management Care Management and Claims Adjudication workflows.
- Experience supporting healthcare applications and business users.
- Ability to work independently in a fast-paced environment.
Work Location & Shift
Location: Kondapur Hyderabad
Work Mode: Work From Office (5 Days a Week)
Shift: 5:30 PM 2:30 AM IST (U.S. Eastern Time Support)
Required Skills:
Minimum 2 years of experience in HIM Healthcare Operations Payor Platforms Claims Processing Provider Data Management or Member Services. Strong understanding of U.S. Healthcare Payor operations. Experience with Claims Eligibility Benefits Authorizations Provider Data or Utilization Management processes. Knowledge of HIPAA regulations and healthcare compliance standards. Strong analytical problem-solving and communication skills.
Required Education:
Bachelors degree in Business Information Technology Engineering Healthcare Administration or a related field.
