Dr. Mehak Dhingra

• Review and process insurance claims (inpatient, outpatient, professional, pharmacy, etc.). According to established procedures.
• Verify member eligibility, provider contracts, and applicable benefits.
• Ensure claims meet policy criteria and contractual obligations before approval or denial.
• Identify and flag discrepancies, coding issues, and potential fraud or abuse.
• Respond to internal and external inquiries related to claims status, payments, or denials.
• Collaborate with medical review teams, customer service, and providers for the resolution of complex claims.
• Maintain documentation and logs of adjudication decisions and adjustments.
• Stay updated on current regulations, payer policies, and compliance standards.

• Assessed incoming claims for validity against policy's conditions and communicated reasons for partial or no payments to clients, enabling fair settlement of valid claims.
• Dealing with patients health care related documents.
• Ensuring error free processing of pre authorization within agreed TAT.
• Entering accurate information into the application defined by the organization.
• Inform providers as needed and file completed pre certification requests as per procedure.
• Any authorization not as per the limit or as per the process to be escalated to the team manger on priority.
• Any medical opinion required from the specialist to be escalated to the specialist.
• Maintaining daily excel maintenance for pre auth cases received and processed.

• Processing of new applications including scrutiny of application form, application fees and required documents in line with documented policies & procedures.
• Assessment scheduling including propose assessment team for assessment and briefing them.
• Co-ordinate the Assessment process with HCF& Assessors.
• Scrutiny of the Assessment report for compliance with the procedure.
• Communicating with HCF and Scrutiny of action planfornon-compliances as reported by the HCF.
• Preparation of cases for presentation to the Accreditation Committee in consultation with the CEO.
• Preparation of Accreditation Certificate.
• Organising Surveillance/ Re-assessment as per schedule.
• Processing and keeping an account of payment to be made to the assessors and by the HCFs to QAI.
• Respond appropriately to any query related to QAI-CAHSC.
• Organising Assessor training programmes.
• Website update and ensure availability of printed documents, if any.
• Organising awareness programmes.
• Sale and Issue of documents and maintenance of inventory in a way to ensure availability of printed documents at all times.
• Maintaining and updating records and data for Board Members, Committee Members and Assessors.
• Formatting documents.
• Preparation of certificates issued for assessor training, awareness programmes etc.
• Support the CEO in quality functions.

• Counselling the patients and help them to get the best services from our staff and hospitals.
• Involved with the service excellence, front desk staff, transcriptions, Op billing and corporate to generate the lead and increase the patient inflow in the health check department.
• Good networking with the prohealth guest and VVIP guest to provide the best services and various testimonies and nice written feedback in our hospitals.
• Grievance Feedback survey to provide the best possible service.
• Implementation of care service persona to digitalize the handwritten prescription.

• Manage By six sigma healthcare

Management of COVID 19 Vaccination drive at Venkateshwar Hospital Evaluation of quality of IP prescriptions at Venkateshwar Hospital

• Case study on Apollo hospital
• Programmed by Apollo hospital