Chandan Kumar

A challenging position in an Esteemed Organization that provides ample opportunities to learn and to contribute.

Sr. Executive at PACIFIC BPO Pvt. Ltd. (2023-01 – Present)

Eligibility Verification – Insurance Verification. Project: US Healthcare Insurance (Medical Billing)

• Responsible for Patients Responsibilities and Member Benefit Plans.
• Following HIPAA Guidelines while working on patient eligibility and Insurance Verification where I need to identify the effective date & Termination Date of policy holder/Subscriber from the Payer Portal.
• Knowledge of Healthcare Software, JACADA, UNET, Encompass, Next Gen, Advanced MD.
• Currently working on Next Gen.
• Evaluate and Processes claims as provided SOP on the behalf of Client Side.
• Reporting of Production by using Google Sheet at Operational Level.
• Weekly Group meeting with supervisor & Quality for growth as well as Organization.

Sr. Process Associates – Insurance Verification at Assimilate solution India Pvt. Ltd. (2020-09 – 2022-10)

Eligibility Verification. Project: US Healthcare Insurance (Medical Billing)

• Knowledge of Patients Responsibilities and Member Benefit Plans.
• Responsible for verify all patient insurance that Active or Inactive with Health Benefit Details.
• Using common web Payer portal for Health Coverage Verification on such kind of portal like Availity, Optum, UHC, Health Net, Evernorth, Alameda Alliance, BRMS, UMR, Blue Shield CA where I need to crosscheck Practice Management (PM) with payer portal for health Insurance benefit and Eligibility Information.
• Verifying the Payer Portal Data whatever need to mention all the missing detail in PM for completion the Eligibility and forward for further Queues.
• Access & Evaluate all the Health benefit which acquired by Payer side like, OOP MET, DED MET CASE, PR MET CASE.
• Reporting of Production records by using Excel Sheet at Operational Level.
• Monthly meeting with supervisor for individually growth as well as Organization.

Claim Associates at United Health Group a/k/a Optum (2018-07 – 2020-08)

US Claim Admin processing. Project: US Healthcare Insurance process (Claim Admin processing)

• Claim Processing of HCFA & UB Healthcare document by given guidelines of company bases instruction.
• Maintaining Records in Excels Sheet.
• Daily Work Completion Report to supervisor.
• Follow up with Quality Analysis Team for Best Quality.
• Working on the Monthly Quality of 99% Accuracy.
• Monthly meeting with Directors for Betterment in Work For Growth of Company

Process Associates at Competent Software Pvt. Ltd. (2009-07 – 2018-02)

US Deed and Mortgage Process

• Data Analyst of Deed and Deed of Trust, Mortgage processed by given guidelines of Company Based onCore Logic.
• Knowledge of Deed, Mortgage, Foreclosure, Auction, Lien.
• Apart from this Working as Quality Analysis of Lower subordinates Files.
• Daily Work Completion Report to Shift-In charge.
• Reporting by using Excel at Operational & Client Level.

Matriculation – C.B.S.E

Intermediate – C.B.S.E

B.A – Delhi University