Dr.Sana N Shaikh
Ghatkopar
Summary
Experienced healthcare professional with over 10 years in clinical patient care and TPA consultancy, transitioning into insurance and non-clinical healthcare operations. Expertise includes managing critical patients, insurance pre-authorizations, medical claims, and utilization reviews. Navigates fast-paced environments, balancing medical decision-making with administrative and regulatory requirements for compliant outcomes.
Overview
12
12
years of professional experience
Work History
TPA Consultant
Dr.L H Hiranandani Hospital
Mumbai
03.2023 - Current
- Processed pre-authorization requests for planned and emergency medical procedures.
- Coordinated with TPA and insurance agencies for claim approvals and clarifications.
- Reviewed and assessed medical claims for cashless treatment and reimbursement, ensuring timely patient access to necessary medical services.
- Ensured compliance with insurance guidelines, policies, and government schemes.
- Validated medical documentation to facilitate accurate and efficient claim processing.
- Monitored claim rejection cases, analyzed reasons, and recommended corrective actions to reduce future rejections.
- Responded to inquiries from insurance companies regarding procedures and patient conditions.
- Trained medical and administrative staff on TPA procedures and documentation requirements.
TPA Consultant
Medi Assist TPA
09.2022 - 08.2023
- 1. Facilitated cashless and reimbursement medical insurance claims, ensuring compliance with company policies.
- 4. Coordinated with TPA companies and insurers to resolve disputes, enhancing claim resolution efficiency.
- 3. Reviewed and verified medical documents for claim approval, maintaining accuracy and reducing processing delays.
- 2. Processed reimbursement requests by verifying expenses and documents.
- 5. Ensured timely submission of pre-authorization requests.
- 6. Educated patients about insurance coverage options and claim procedures.
- 7. Collaborated with hospital billing teams for claim settlements.
- 8. Monitored claim rejections, suggesting corrective actions.
TPA Consultant
Fortis Hospital
Kalyan
01.2021 - 01.2022
- Reviewed and assessed medical claims for cashless treatment, ensuring timely reimbursement for patients.
- Processed pre-authorization requests for planned and emergency procedures.
- Coordinated with TPA and insurance agencies to secure claim approvals and clarify processing issues, enhancing communication efficiency.
- Ensured compliance with insurance guidelines, policies, and government schemes.
- Responded to queries from insurance companies regarding medical procedures and patient conditions.
- Validated medical documentation required for claim processing.
- Collaborated with hospital billing and finance departments for seamless claim settlements.
- Monitored claim rejections, analyzed reasons, and implemented corrective actions to reduce future discrepancies.
Clinical Associate - Geneal & Obs
Anand Chandavarkar Multispeciality Hospital
Wada
01.2019 - 01.2020
- Managed labor and delivery cases, ensuring safe outcomes under senior consultant supervision.
- Assisted in gynecological surgeries, including C-sections and laparoscopic procedures.
- Facilitated gynecological consultations and procedures, improving patient access to care.
- Conducted antenatal and postnatal check-ups while providing essential patient guidance.
- Interpreted diagnostic reports and recommended appropriate treatment plans.
- Maintained accurate patient records, ensuring compliance with hospital protocols.
- Educated patients on reproductive health, contraception, and postnatal care.
- Collaborated with multi-disciplinary teams to coordinate comprehensive patient care.
Resident Medical Officer
Shantiniketan Hospital
Ghatkopar
01.2017 - 01.2019
Resident Medical Officer
Ashbin Hospital
Dadas
01.2014 - 01.2016
Resident Medical Officer
Dr. Sonagra Medical & Surgical Centre
Ghatkopar
01.2014 - 01.2015
Education
PGDBM - Operations
Narsee Monjee Institute of Management Science
Mumbai07-2025
Bachelor of Ayurveda Medicine & Surgery - Medicine
YMT Ayurvedic Medical College & Hospital. P.G.Inst
Kharghar01.2013
Skills
- Medical insurance processes & claim management
- Hospital administration & clinical operations
- Medical claim processing & insurance coordination
- Compliance management & regulatory adherence
- Clinical documentation & report review
- Patient advocacy & support services
- Interpersonal & stakeholder communication
- Problem-solving & clinical decision-making
- Process improvement & operational efficiency
- Data analysis & healthcare operations analysis
- Organizational & time management skills
- Detail-oriented review & quality assurance
- Team collaboration & cross-functional engagement
- Adaptability & continuous professional learning
- Issue resolution & escalation management
- Goal setting & timeline managementMS office
- MS Office
Personal Information
- Date of Birth: 07/31/91
- Nationality: Indian
- Marital Status: Married
Languages
English
Proficient (C2)
C2
Marathi
Proficient (C2)
C2
Hindi
Native
Native
Timeline
TPA Consultant
Dr.L H Hiranandani Hospital
03.2023 - Current
TPA Consultant
Medi Assist TPA
09.2022 - 08.2023
TPA Consultant
Fortis Hospital
01.2021 - 01.2022
Clinical Associate - Geneal & Obs
Anand Chandavarkar Multispeciality Hospital
01.2019 - 01.2020
Resident Medical Officer
Shantiniketan Hospital
01.2017 - 01.2019
Resident Medical Officer
Ashbin Hospital
01.2014 - 01.2016
Resident Medical Officer
Dr. Sonagra Medical & Surgical Centre
01.2014 - 01.2015
PGDBM - Operations
Narsee Monjee Institute of Management Science
Bachelor of Ayurveda Medicine & Surgery - Medicine
YMT Ayurvedic Medical College & Hospital. P.G.Inst