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
