HIM Analyst Payor Platform

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.
  
  

• Bachelor's 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.
  
  

• 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)
  
  

• 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.