Deepa Bharti
Senior Associate
Gurugram
Summary
Experienced healthcare professional with 5.5 years in U.S. healthcare claim Adjudication, specializing in DNFB, CNFB, FMLA, and disability claims. Proven expertise in accurate claim processing, policy interpretation, and regulatory compliance. Skilled in identifying claim discrepancies, ensuring timely resolutions, and maintaining data integrity while ahereing to HIPAA guidelines. Strong understanding of healthcare regulations and patient confidentiality standards, with a commitment to delivering quality and efficient adjudication services in a fast-paced environment.
Overview
7
7
years of professional experience
Work History
Senior Analyst
R1 RCM
03.2024 - Current
- Monitor and manage DNFB and CNFB accounts to ensure timely claim submissions and reduce billing delays.
- Collaborate with providers and coding teams to resolve documentation or coding deficiencies preventing final billing.
- Analyze root causes for DNFB hold statuses and implement corrective actions to streamline the revenue cycle.
- Maintain compliance with HIPAA and payer-specific guidelines while processing Accounts.
- Train and mentor junior analysts in DNFB processes, helping them improve accuracy and efficiency.
Process Associate
Genpact India Pvt Ltd
11.2021 - 05.2023
- Processed and adjudicated short-term disability claims as part of the US group insurance workflow and Managed employee leave programs including Short-Term Disability (STD), FMLA and personal leaves
- Ensured claims were handled in compliance with HIPAA regulations and client-specific guidelines.
- Coordinated with healthcare providers and employers to gather additional information and clarify claim details.
- Met or exceeded performance metrics, including accuracy, turnaround time (TAT), and productivity.
Senior Executive
EXL Services
08.2018 - 08.2021
- Reviewed and processed healthcare claims in accordance with U.S. healthcare policies, provider contracts, and payer guidelines.
- Analyzed and adjudicated supplemental claims dental and vision for accuracy, eligibility, and compliance with insurance plan benefits.
- Identified and resolved discrepancies related to claim payments, denials, and coordination of benefits (COB).
- Ensured HIPAA compliance and protected sensitive patient information during all phases of claim processing.
- Communicated with internal teams and payers to clarify policy and coding issues affecting claim decisions
- Demonstrated knowledge of CPT, ICD-9 and ICD-10, and HCPCS codes for validating medical necessity and claim eligibility.
- Managing Co-pay, Co-Insurance and Deductible as defined by the policy standards and policy documents.
Education
ANIIT Software Professional (Software Engineer) - Computer Science
2017
Bachelor Of Arts - Arts
2014
Senior Secondary - Arts
2011
Skills
Claims Adjudication
Dental claim processing
DNFB (Discharged Not Final Billed) and CNFB (Coded Not Final Billed)
Disability and FMLA Claims Processing
Medical Coding (ICD-10, ICD-9, CPT, HCPCS)
Knowledge of Healthcare Platforms used in Insurance processing companies or process
US Healthcare Regulations & Compliance
Timeline
Senior Analyst - R1 RCM
03.2024 - Current
Process Associate - Genpact India Pvt Ltd
11.2021 - 05.2023
Senior Executive - EXL Services
08.2018 - 08.2021
NIIT - ANIIT Software Professional (Software Engineer), Computer Science
CSJM University Kanpur - Bachelor Of Arts, Arts
DBRAIC - Senior Secondary, Arts