Ayushi Gupta
Kanpur
Summary
A dynamic professional with 5 years of experience in US healthcare Claims and payments appeal Specialist. Achieved 98%+ claim accuracy at Capgemini through meticulous attention to detail and proactive problem-solving. Expert in processing and quality reviewing, enhancing efficiency and client engagement.
Overview
5
5
years of professional experience
1
1
Certification
Work History
Senior Associate
Wellcove by CHCS Services
Noida
08.2021 - Current
- Proficient in disease and drug knowledge, staying updated on the latest developments.
- Handles CPT and ICD-10 coding, Surgery schedule, Anesthesia, and Benefits codes.
- Skilled in the case-handling process, ensuring efficiency and accuracy.
- Maintains strict compliance with HIPAA guidelines and regulations.
- Reviews and processes health appeals, performing eligibility checks, document validations, and quality assurance.
- Expert in reviewing medical documents and literature for accuracy and relevance.
- Supported appeals and reconsideration processes by preparing claim justifications and rebuttal summaries.
Process Associate
Capgemini
Noida
11.2020 - 07.2021
- Processed and reviewed cancer insurance claims for accuracy, eligibility and completeness in compliance with company and client policies.
- Handled claim documentation includes Proof of loss(POL), Benefit Determination Period (BDP), and Explanationation of benefits(EOB).
- Achieved 98%+ claim accuracy rate by consistently adhering to quality standards and internal audit requirement.
- Ensured timely turnaround of claim settlements, often exceeding SLA expectations.
- Coordinated with internal teams and clients to resolve discrepancies, clarify claim information, and ensure timely processing.
- Ensured timely turnaround of claim settlements, often exceeding SLA expectations.
- Worked on claim maintenance, benefit adjustments, and overpayment resolutions in alignment with policy guidelines.
Education
Bachelor of Science - Pharmacy
Pranveer Singh Institute of Technology
Kanpur, UP01.2020
12th -
Huddard High School
Kanpur, UP01.2014
Skills
- Processing and quality reviewing of ICSR
- Pharmacovigilance training
- Counselling patients
- Monitoring
- Researching
- Assessing
- Evaluating information
- Literature Screening
- Literature Triage
- Proactive approach
- ICSR Safety
- Problem solving
- Attention to detail
- Account reconciliation
- Client engagement
Certification
Pharmacovigilance, 01/01/20, Attended various workshop on Pharmacovigilance and topics such as drug safety and data efficacy. Hindi Pharmacology Pharmaceutics.
Accomplishments
- Attended Technology Based Entrepreneurship Development Programme for 36 days organized by NSTEDB at PSIT Kanpur.
- Awarded as star performer in AKTU sponsored National Conference Role of Intellectual Property Protection In Industry and Device Development.
- Organization Head EAD organized by IIT Kharagpur, at PSIT, Kanpur (5 day event).
- Event Head IGNITIA College Cultural Fest, Kanpur.
Projects
A review article on Recent Advancements in the Treatment of Diabetic Retinopathy.
Disclaimer
I hereby declare that the information given above is genuine to the best of my knowledge & if given an opportunity to work in your organization, I will put my best efforts.
Languages
- Hindi
- English, First Language
- Hindi, First Language
Internship
- Hospital Pharmacy Intern, Bombay Hospital & Trauma Centre, Gorakhpur, 90-day training
- Trainee, Ultratech Pharmaceuticals, Solan, Himachal Pradesh, 09/01/18 - 10/31/18
Timeline
Senior Associate
Wellcove by CHCS Services
08.2021 - Current
Process Associate
Capgemini
11.2020 - 07.2021
Bachelor of Science - Pharmacy
Pranveer Singh Institute of Technology
12th -
Huddard High School