Enthusiastic Accounts Cum Administrative Executive eager to contribute to team success through hard work, attention to detail and excellent organizational skills. Clear understanding of Accounts and Administrative activities and Trained in ERP9 Software. Motivated to learn, grow and excel in any organization.
● Well experienced in manual claim adjudication of Outpatient, office visits claims.
● Excellent understand of payment posting for claims submitted by various individual providers and facilities like hospitals, laboratories and radiology centres.
● Responsible for manual adjudication of failed medical claims with contract provisions using online documentation policies and releasing the payments to the Patients/Providers.
● Responsible to understand and apply member plan concepts like Deductible, Coinsurance, Co-pay, Out-of-pocket accurately.
● Updating all the client expectations and day to day changes in online documentation.
● Manage aged claims to save the penalty payments.
● Sending out the daily quality scores along with the feedback.
● Managed all the reporting work like allocation of claims data and suspended claims to team members in the supervision on team manager.
● Create audit reports daily for High dollar claims, internal and external errors and publishes to the team.
● Upgrading of database using Net term & Exceptional Reports.
● Reviewing productivity and quality and sending Scan Response sheet to the clients and performance reports by giving regular feedback on their productivity and quality.
● Error rectification & maintaining standards of Quality as an important function of Quality Department.
● Committed and dedicated team work towards in the growth of company.
● Capable of Handling Multiple Assignments and completed tasks in schedule.
[Type] documentation and reporting
● Achieved Star Awards for the year 2014, 2015 and 2016.
● Awarded High Performer of the Year 2017.