Dr.Smruti Ranjan Biswal
Bhubaneswar
Summary
Dynamic Medical Claims Manager with extensive experience at KAR CLINIC & HOSPITALS LTD, adept at optimizing reimbursement processes and enhancing claim resolutions. Proven expertise in medical billing and coding, coupled with strong communication skills, driving efficiency and accuracy in insurance claims management. Committed to improving operational standards and patient satisfaction.
Overview
15
15
years of professional experience
Work History
MASTER IN DENTAL SURGERY
HITECH DENTAL COLLEGE AND HOSPITAL
Bhubaneswar
12.2022 - Current
MEDICAL CLAIMS MANAGER
KAR CLINIC & HOSPITALS LTD
Bhubaneswar
10.2019 - 11.2025
- Following up on claims from billing to final resolution and obtaining necessary medical and financial information from patients or doctors as well as contacting different insurance companies for benefit investigation and coverage eligibility
- Preparing and reviewing claims as well as identifying and correcting billing errors, and resubmitting claims to insurance companies
- Obtaining financial verification and pre-certification or authorization as required for patients' visits as well as documenting the related information according to defined process in a timely manner
- Translating insurance benefits to patients as well as answering their questions related to billing procedures, insurance coverage plans, and claim procedures
- Maintaining and improving quality results by adhering to established standards and guidelines and recommending improved procedures as well as providing reviews and remittance advice for payment errors, denials, and under payments
- Reviewing and writing of pre –authorisation claim with mentioning proper medical terminologies and exact treatment procedure which has to be performed for easy and hassle free claim approval
- Coordinated with payers to evaluate various denial claims, and to maximize reimbursements
SENIOR MEDICAL OFFICER
PARAMOUNT HEALTH SERVICES
Bhubaneswar
08.2017 - 09.2019
- Monitoring the overall operations of Claims
- Responsible for ensuring efficient response at the level of Preauthorization to maintain TAT
- Ensure adherence to processes and controls
- Creating the process for Claim processing (Cashless and Reimbursement)
- Co-ordination between Network Hospitals
- Processing of RSBY & BKKY mass policy claims
MEDICAL OFFICER
ALANKIT HEALTH CARE(TPA)
Rohini
01.2014 - 08.2017
- Doing settlement of all mediclaims (CASHLESS AND REIMBURSEMENT)
- Dealing with all individual claims as well as corporate claims
- Visit to FIS CORPORATE GURGAON for ghmi claim settlement
Smilez4u Dental Clinic
Bangalore
04.2012 - 01.2014
- Company Overview: Headed by Dr.Reetu sharma
- Headed by Dr.Reetu sharma
Compulsory rotary internship
Dr.Syamala Reddy Dental College
Bangalore
03.2011 - 03.2012
Education
BDS -
Dr Syamala Reddy Dental College
Bangalore01.2010
MDS -
Hitech Dental College
BhubneswsarSkills
- Medical billing and coding
- Insurance claims process
- Authorization
- Communication skills
- Interpersonal skills
- Customer-service skills
- Computer skills
- MS Office Suite
- Database applications
- Coding software
- EHR system
- Internet
- Analytical skills
- Critical thinking skills
- Organizational skills
- Multi-tasking skills
- Reimbursement processing claims
- Cashless processing claims
- BSKY claims
- BSKY mass policy claims
Disclaimer
I hereby declare that the above-mentioned information is correct up to my knowledge and I bear the responsibility for the correctness of the above-mentioned particulars.
Hobbies and Interests
- Fishing
- Cooking
- Reading
Personal Information
- Father's Name: Brundaban Biswal
- Gender: Male
- Nationality: Indian
- Marital Status: Single
Timeline
MASTER IN DENTAL SURGERY
HITECH DENTAL COLLEGE AND HOSPITAL
12.2022 - Current
MEDICAL CLAIMS MANAGER
KAR CLINIC & HOSPITALS LTD
10.2019 - 11.2025
SENIOR MEDICAL OFFICER
PARAMOUNT HEALTH SERVICES
08.2017 - 09.2019
MEDICAL OFFICER
ALANKIT HEALTH CARE(TPA)
01.2014 - 08.2017
Smilez4u Dental Clinic
04.2012 - 01.2014
Compulsory rotary internship
Dr.Syamala Reddy Dental College
03.2011 - 03.2012
BDS -
Dr Syamala Reddy Dental College
MDS -
Hitech Dental College
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