Md Reza

Healthcare Revenue Cycle Management professional with hands-on experience in Prior Authorization, Verification of Benefits (VOB), eligibility verification, payer communication, medical-record review, CPT and diagnosis (DX) validation, and authorization follow-up. Experienced in obtaining authorizations for DME, CPAP, oxygen regulators, radiology, cardiology, pediatric, and fetal procedures while maintaining quality and TAT requirements.

Billing Representative – Prior Authorization & VOB - Modern Practice Solutions

(2023-09 - 2025-12)

• Handled Prior Authorization and Verification of Benefits processes for multiple healthcare specialties and procedures.
• Obtained authorizations for DME, CPAP, oxygen regulators, radiology, cardiology, pediatric, and fetal procedures.
• Reviewed CPT codes and diagnosis (DX) to validate authorization requirements and ensure the request matched the documented service.
• Reviewed medical records and identified the appropriate documentation required to support authorization requests.
• Submitted proper medical records and supporting documentation to payers for authorization approval through portals, fax, and calls.
• Followed up with payer representatives and monitored authorization status through completion.
• Verified patient eligibility and benefits through payer portals and calls, including copay, deductible, and coinsurance.
• Prepared patient out-of-pocket estimates for appointments based on verified benefits.
• Performed self-auditing of authorization work to ensure accuracy, documentation completeness, quality, and compliance with process requirements.
• Maintained quality and TAT standards across assigned authorization and billing activities.

AR Representative - Clinic Anywhere Pvt Ltd

(2022-07 - 2023-06)

• Managed AR activities with focus on prioritizing aged claims.
• Worked on rejections and different types of denials and followed up for timely resolution.
• Maintained required TAT and supported reduction of outstanding AR.

Senior Process Associate - Su Knowledge PVT LTD

(2018-10 - 2022-01)

• Worked across multiple healthcare projects based on client requirements, including AR, VOB, and Authorization processes.
• Supported authorization-related activities and maintained required TAT across assigned processes.