AR Caller Executive - Global Health Care
(2022-05)
Working as an AR Caller Executive handling claims and billing inquiries with HIPAA compliance and insurance coordination.
- Initiate calls requesting status of claims in queue.
- Ensured HIPAA compliance.
- Utilized strong assessment skills to determine medical necessity for post payment denials
- Actively maintained up-to-date knowledge of applicable state and Federal laws and regulations for billing and appeals.
- Observed strict confidentiality and safeguarded all patient-related information.
- Cooperated with Medicare, Medicaid and private insurance(MCO's, MSP, WC) providers to resolve billing issues.
- Knowledge of ICD10, CPT, HCPC Codes.
- Contact insurance companies for further explanation of denials and underpayments
- Take appropriate action on claims to guarantee resolution.
- Ensure accurate and timely follow-up where required.
- Document actions taken in claims billing summary notes
Assistant Manager - Puri Crawford Associates India Pvt Ltd
(2012-08 - 2022-02)
Worked as a Medical Writer & Pre-approver in Puri Crawford for Johnson & Johnson project (DePuy ASR, Recalled Implant in the year 2010)
- Identification of ASR Patients
- Validating ASR Patients
- Regular Monitoring of Metal ion levels of ASR patients with other Laboratory Investigations
- Preparing Clinical note & referring patient's clinical data's with Surgeons clinical justifications to Vigilance & Medical teams
- Reviewing Implant & Explants of ASR patients who undergone for Revision surgery.
- Claim Processing: After attending to the queries and claim related issues, register the claim after knowing all facts and figures & processing all the documents as per the Service Standards & Norms of the business. Follow Up, Obtain & verify all documents. Resolve all the queries in time bound manner.
- Documentation & Reporting: Keep proper record of all the documents and correspondences. Keep data updated on e-claims. Sends weekly MIS to DePuy Client. Does file management efficiently as it is subject to audit by DePuy Client.
- Payment Follow Ups & Reimbursements: Following up with corporate office at Mumbai and getting the payment processed and settlement for reimbursements, once the claim is approved, verified and authentic. Follow the TAT (all the bills to be cleared within 7 days of receipt).
Operation Executive (Travel) - Bajaj Allianz Gen Insurance Company
(2008-09 - 2012-05)
Worked as an Operation Support Executive in Bajaj Allianz for Travel Department
- Issuance of Error free policies and endorsements for Corporates & Retail.
- Maintenance of Monthly & Weekly MIS to Corporates & Daily MIS to Retail.
- Handling claims queries for Corporates & Retail.
- Maintenance of monthly MIS reports-provide weekly business completion report to the marketing team.
- Consistency in the Productions as well as in Productivity.
- Achieved accuracy in handling timeless & target in productivity with quality assurance.
