Heena Kouser

Detail-oriented and analytical Medical Billing & Coding Process Expert with a robust background in financial processes, claims management, and data validation. Proven track record in auditing claims for high accuracy, verifying member eligibility, and streamlining the claims lifecycle to maximize revenue and minimize insurance denials. Combines an MBA in Finance with hands-on experience in high-volume healthcare claims environments to deliver exceptional operational efficiency and regulatory compliance.

Claims Executive (Medical Billing & Coding Specialist) - Satmed Claims Service Pvt. Ltd.

• Demographics & Eligibility Verification: Managed intake of customer medical documents, successfully verifying insurance eligibility, and accurately provisioning unique Customer IDs within the core system database.
• Claims Processing & Adjudication: Streamlined data entry and processing of medical billing documents, ensuring absolute alignment with organizational SLAs and healthcare regulatory guidelines.
• Quality Assurance & Auditing: Conducted rigorous audits on submitted claims to guarantee high accuracy levels, identifying discrepancies, checking for policy compliance, and mitigating fraud/waste/abuse.
• Workflow Optimization: Facilitated smooth end-to-end operational workflows by securely routing audited and approved financial claims directly to the payment disbursement team.

M.B.A. - Finance - Sri Chaitanya P.G. College (2010-01 - 2012-12)

B.Com - Computers - Shivani Degree College (2010-01 - 2010-12)

Intermediate - Paramitha Junior College (2007-01 - 2007-12)

S.S.C. - Z.P. High School (2005-01 - 2005-12)