Summary
Overview
Work History
Education
Skills
Accomplishments
Certification
Languages
Personal Information
Certifications
References
Timeline
Generic

Mario Lobo

Ahmedabad

Summary

A dedicated professional with more than 6 years of experience in revenue cycle management in different domains such as Insurance Calling, PCP Calling, Charge Entry, Billing, Coding, Eligibility & Benefits, Referral Authorization for U.S. based healthcare industry.

Overview

8
8
years of professional experience
1
1
Certification

Work History

Senior Analyst

EmpClaims
01.2024 - Current
  • AUDIT: Conducted audits to identify and correct discrepancies in charge entries and patient records for Internal Medicine & Urgent care specialist providers in PMS such as AdvancedMD & Experity.
  • Investigated and resolved discrepancies in documentation or coding by coordinating with providers and coders.
  • Addressed and rectified denied or delayed claims related to charge entry issues.
  • Verified CPT, ICD-10, and HCPCS codes for compliance with payer requirements and organizational policies.
  • Achieved timely submission of claims, ensuring adherence to strict deadlines.
  • Maintained compliance with HIPAA regulations and other healthcare standards in all charge entry processes.
  • Verified patient insurance coverage and ensured necessary authorizations for billed procedures.

Senior Medical Biller

SGN Technology Services
06.2021 - 01.2024
  • E&M Medical billing and coding for Internal medicine & Gynecology providers (New York).
  • Preparing, reviewing, and transmitting claims using eClinicalWorks EMR.
  • Preparing progress notes for Annual Wellness Visit (AWV).
  • Coordinate, complete, and update management on all HEDIS processes and results.
  • Organize and maintain a plan of action to improve MIPS scores.
  • Ensure compliance by maintaining all data in ePASS® Patient Assessments.
  • Obtaining referrals as required for procedures.

Executive - Referrals

Omega Healthcare
09.2019 - 08.2020
  • Initiate referrals from primary care providers for Cancer specialty (Florida) in a timely manner, prioritizing the referrals according to defined levels of urgency and communicating referral information to providers on Centricity & OncoEMR.
  • Maintain ongoing tracking and appropriate documentation on referrals.
  • Adhere to company HIPAA policies and procedures. Identifying, maintaining and protecting sensitive HIPAA information (PHI) and following procedures to ensure the security of such information
  • Verify member’s eligibility and benefits with subsequent notification to staff of eligibility issues.
  • Request submission of appropriate medical records according to established criteria for requested service(s) in accordance with the corresponding Policy.
  • Verify fax numbers and system updates. Communicates with requesting provider for any identified need to clarify a request for an authorization, such as CPT codes, ICD10, requested timeframes and member’s demographics.
  • Provide effective departmental communication with both internal and external sources and provide services to providers per UM Departmental Policy and Procedures and specific contracted Client's process on a time.

Professional Dancer

Freelance
12.2018 - 08.2019
  • Choreographed dance routines for events.

Junior Executive - EV/BV/Auth

Fedora Solutions
07.2017 - 11.2018
  • Worked for Tennessee and Maryland based projects for cancer specialty with software like eClinicalWorks and OncoEMR.
  • Verification process like validation of medical eligibility and coverage through portal or calling respective insurances.
  • Verifying patient specific benefits and precisely documenting specifics for various payer plans including patient coverage, cost share, and access/provider options according to Program specific SOPs.
  • Complied with all HIPAA, Accreditation and Insurance guidelines.
  • Collecting and review all patient insurance information needed to complete the benefit verification process.
  • Review Orders and call the insurance company to determine if authorizations is required for chemo drugs.
  • Obtain & document Authorization or Benefits template in EHR/EMR.
  • Utilize knowledge of CPT, ICD-10 and HCPCS coding when verifying insurance.
  • Researching and identifying other active primary, secondary or tertiary insurances in case of the existing insurance policy getting termed.
  • Maintaining the query sheet to identify and solve complications in regards to the patient’s coverage or coordination of benefits issue.

Education

Bachelor of Commerce -

SAURASHTRA UNIVERSITY
03-2014

HSC -

GUJARAT HIGHER SECONDARY EDUCATION BOARD
03-2011

SSC -

GUJARAT SECONDARY BOARD
03-2009

Skills

  • Revenue-based analysis
  • Teamwork
  • Adaptability

Accomplishments

  • Champion at work - FEDORA SOLUTIONS -2018
  • Clash of Corporate Finalist - RADIO MIRCHI 98.3 FM - 2014
  • Selected by RAGHAV JUYAL - Muqabala Dance Competition
    Choreography Round - 2013
  • Selected by PRINCE GUPTA - Muqabala Dance Competition - 2013

Certification

BASIC COMPUTER SCIENCE CERTIFICATION

Languages

Hindi
Proficient
C2
Konkani
Intermediate
B1
Gujarati
Intermediate
B1
English
Bilingual or Proficient (C2)

Personal Information

Title:

Certifications

02-2009

References

  • Will be provided on request.

Timeline

Senior Analyst

EmpClaims
01.2024 - Current

Senior Medical Biller

SGN Technology Services
06.2021 - 01.2024

Executive - Referrals

Omega Healthcare
09.2019 - 08.2020

Professional Dancer

Freelance
12.2018 - 08.2019

Junior Executive - EV/BV/Auth

Fedora Solutions
07.2017 - 11.2018

Bachelor of Commerce -

SAURASHTRA UNIVERSITY

HSC -

GUJARAT HIGHER SECONDARY EDUCATION BOARD

SSC -

GUJARAT SECONDARY BOARD

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