Riyaz Sheriffe

To secure a position with a well-established organization with a stable environment that will enable me to use my strong organizational skills and educational background and contribute to the organization.

SME - COGNIZANT TECHNOLOGY SOLUTIONS INDIA PVT LTD

(2022-02)

Domain (US Process)

• Analyzing of Payer Claims (EDI and Paper) for the credibility to the Provider or member.
• Analyzing both Professional and Facility claims and decide whether to pay or denied the claim as per the guidelines in various specialties.
• Received the processed overpaid, underpaid and denied claims through mail and analyze the processed claim and adjust the claim as per the P&P and finalize the Denied and Paid claims.
• Analyze the claim and request the information from Patient or Provider for needed specialty claims.
• Working for provider, adjust the claims based on provider appeal request or uphold the original decision as per processing guidelines
• Pay the claim lower than the claimed amount based on the business rules.
• Work on both HCFA and UB Claims. Handling Illinois.

Senior Process Associate - ACCUMED HEALTH CARE

(2019-05 - 2022-01)

Domain (US Process)

• Performed on-site billing and collection for all Central Business Office.
• Interacted directly with on-site personnel.
• Computed all ancillary charges.
• Resolved billing and charge entry issues.
• Maintained time cards for payroll.
• Assisted with month end close.
• Received and reviewed charge documents.
• Billed and entered charges in a timely manner.
• Accurately updating Providers (Doctors) and Hospital records with exact information
• Able to respond and adapt all the needs of all Doctors and Hospitals
• Handling complaints in a diplomatic way.
• Fully aware of all laws & regulations regarding data protection
• Verifying queries regarding Doctors or Hospitals Name, Address quickly and effectively. Quickly processing information
• Trained in multiple process like Correspondence SB 137 letter Roster, MAPO Letter Roster, PLM Letter Roster

Transaction Process Associate - ACCENTURE

(2017-05 - 2019-01)

Domain (US Healthcare)

• Accurately updating Providers (Doctors) and Hospital records with exact information
• Able to respond and adapt all the needs of all Doctors and Hospitals
• Handling complaints in a diplomatic way.
• Fully aware of all laws & regulations regarding data protection
• Verifying queries regarding Doctors or Hospitals Name, Address quickly and effectively. Quickly processing information
• Trained in multiple process like Correspondence SB 137 letter Roster, MAPO Letter Roster, PLM Letter Roster

Manager - Shoe company

(2015-08 - 2017-01)

• Manage staff and assign duties
• Determine merchandise and services to be sold and implement price and credit policies
• Locate and select and procure merchandise for resale
• Develop and implement marketing strategies
• Plan budgets and authorize expenditures
• Resolve customer complaints

BCA - THE NEW COLLEGE (2012 - 2015)