Madhuri Birajdar

Dedicated and detail-oriented healthcare claims processing auditing with a strong understanding of HIPAA guidelines and extensive experience in Medicare, Medicaid, medical records review, DME, and inpatient/outpatient claims. Adept at using Encoder Pro for accurate diagnosis and HCPCS coding. Seeking to leverage my expertise to contribute to the efficiency and compliance of a reputable healthcare organization.

Claims Adjudication Specialist - Concentrix - Pune

(2022-10-11 - 2026-05-05)

• Manage DME claims, ensuring proper documentation and adherence to coverage criteria.
• Process and review Medicare and Medicaid claims to ensure accuracy and compliance with federal guidelines.
• Conduct thorough medical records reviews to support claim decisions.
• Handle both inpatient and outpatient claims, coordinating with healthcare providers for necessary information.
• Submit corrected claims and follow up on claim status to resolve discrepancies.
• Utilize Encoder Pro for precise diagnosis and HCPCS coding, reducing errors and denials.

Bachelor of Commerce