MD Office
Mitesh Kariya
US Medical Billing Specialist
Summary
Reliable business professional with experience in project management, process improvement and financial analysis. Proven track record of successfully streamlining business operations and reducing costs. Adept at analyzing data to identify trends and developing strategies to improve efficiency.
Overview
8
8
years of professional experience
2
2
Certifications
1
1
Language
Work History
Team Leader
Integrity Healthcare Solutions PVT LTD.
03.2022 - Current
- Mentored and guided employees to foster proper completion of assigned duties.
- Conducted training and mentored team members to promote productivity, accuracy, and commitment to friendly service.
- Conducted training and mentored team members to promote productivity and commitment to friendly service.
- Built strong relationships with customers through positive attitude and attentive response.
- Established open and professional relationships with team members to achieve quick resolutions for various issues.
- Worked with team to identify areas of improvement and devised solutions based on findings.
- Monitored time and attendance, enforcing compliance with company procedures relating to absenteeism.
- Supervised team members to confirm compliance with set procedures and quality requirements.
- Managed leave requests and absences and arranged covers to facilitate smooth flow of operations.
- Monitored team performance and provided constructive feedback to increase productivity and maintain quality standards.
- Communicated KPIs outlined in annual plan to inform employees of expectations and deliverables.
- Reviewed, implemented and updated company records related to team activities for future reference.
- Held weekly team meetings to inform team members on company news and updates.
- Developed effective improvement plans in alignment with goals and specifications.
- Provided reporting for forecast analysis and ad-hoc reporting in support of decision-making.
- Frequently inspected production area to verify proper equipment operation.
- Evaluated staff performance and provided coaching to address inefficiencies.
- Conducted regular reviews of operations and identified areas for improvement.
- Educated staff on organizational mission and goals to help employees achieve success.
- Collected, arranged, and input information into database system.
- Generated reports detailing findings and recommendations.
- Devised and implemented processes and procedures to streamline operations.
- Maintained database systems to track and analyze operational data.
- Conducted training and mentored team members to promote productivity and commitment to friendly service
- Communicated KPIs outlined in annual plan to inform employees of expectations and deliverables
- Supervised team members to confirm compliance with set procedures and quality requirements
Team Leader
Axial Health PVT LTD
06.2021 - 02.2022
- Conducted training and mentored team members to promote productivity and commitment to friendly service.
- Assisted with improving revenue and customer numbers by overseeing implementation of diverse sales and service initiatives.
- Increased overall efficiency and productivity of team by revamping jobs, schedules and daily assignments.
- Maintained team compliance with company standards, safety practices and regulatory and environmental requirements.
- Improved team efficiency and productivity by restructuring workflow and managing assignments.
- Trained, coached and managed 22-person team of 18 and 4 professionals.
- Set schedules and oversaw daily workflow.
- Helped set and manage objectives for quality, productivity and compliance.
- Managed high workload with consistent record of achieving deadlines and production targets.
- Sat on new hire interviewing panel and made recommendations.
- Contributed to interviewing process and made new hire recommendations.
- Kept team activities in compliance with safety, regulatory and environmental guidelines.
- Adhered to applicable guidelines and requirements, and assisted team in doing same.
- Produced detailed reports outlining performance against benchmarks.
- Encouraged and promoted ideas aligned to business needs and benefits.
- Motivated and trained employees to maximize team productivity.
- Compiled training materials for new employees and tracked skill development.
- Collected customer feedback and made business adjustments to improve retention and satisfaction.
- Managed internal operational standards and productivity targets.
- Analyzed department metrics and performance and reported findings to management.
- Conducted root cause analysis in deficient areas to identify and resolve issues.
- Evaluated team member performance and productivity, provided feedback and implemented corrective actions.
- Accomplished multiple tasks within established timeframes.
Senior Process Associate
I Global KPO Services LLP
06.2020 - 07.2021
- Implemented new accounting processes to decrease spending and work flow downtime.
- Managed and responded to correspondence and inquiries from customers and vendors.
- Maintained account accuracy by reviewing and reconciling checks monthly.
- Effectively communicated with clients about payment needs and kept updated, detailed and accurate ledgers.
- Handled day-to-day accounting processes to drive financial accuracy.
- Reduced financial discrepancies, effectively reconciling patient accounts and organizing information into accounting software.
- Reconciled accounts, managed audits and updated financial records with remarkable accuracy.
- Maintained the AR by aging wise and follow up claims within project requirement time frame.
- Training to new employee for RCM process along with the Training modules.
- Manage the audit of Insurance and managing recoupment and refund process.
- Out of Network provider/Facility Negotiation Process to Enhance Revenue of project.
- Credentialing process for behavioral health specialist with multiple Insurance companies i.e. Aetna, Cigna Healthcare, UHC, etc.
Senior Process Associate
Adroit BPO KPO Services LLP
08.2018 - 05.2020
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Adhered to established standards to safeguard patients' health information.
- Posted payments and collections on regular basis.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Liaised between patients, insurance companies, and billing office.
- Reviewed patient records, identified medical codes, and created invoices for billing purposes.
- Delivered timely and accurate charge submissions.
- Collected payments and applied to patient accounts.
- Verified insurance of patients to determine eligibility.
- Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
- Generated reports and analyzed trends to maximize reimbursement and reduce claim denials.
- Utilized financial software to prepare consolidated financial statements.
- Established internal audit procedures to validate and improve accuracy of financial reporting.
Senior Associate
Fedora Solutions PVT LTD
10.2015 - 08.2018
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Assisted patients with understanding personalized insurance coverage and benefits.
- Trained new staff on current, correct insurance verification procedures.
- Chased insurance companies to achieve accurate and timely payments.
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Updated patient records with accurate, current insurance policy information.
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
- Established and maintained relationships with insurance providers for productive communications.
- Achieved insurance pre-authorizations to enable timely patient procedures.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
- Prepared and processed patient referrals and transfer requests.
- Ensure for each patient date of services whether the pre-certification and Referral is required prior to rendered services and obtained from Primary care Physicians and Insurance as process .
Education
Bachelor of Commerce - Commerce
J K Ram Collage
Veraval 03.2013 - 03.2015
High School Diploma -
Excel Institute of Diploma Studies
Kalol 04.2009 - 04.2013
H.S.C - Commerce
Boys High Schools
Veraval 10.2011 - 03.2012
K.K.Mori High School
Veraval 04.2008 - 03.2009
Skills
Complaint Resolution
Overtime Management
Quality Improvement
Coaching
Mentoring
Technical Support
Work Planning
Employee Evaluation
Client Service
Key Performance Indicators
Performance Improvement
Account Management
Problem-Solving
Onboarding and Orientation
Complex Problem-Solving
Daily Workflow Improvement
Documentation and Reporting
Team Supervision
Leading Team Meetings
People Management
Team Motivation
Teamwork and Collaboration
Giving Constructive Feedback
Performance Evaluations
Evaluating Employee Work
Software
Onco EMR
E-Clinical Works
MD Land
KIPU
Practice Fusion
Zen Chart
IMS
Collaborate MD
Certification
Six Sigma White Belt
Timeline
Six Sigma Yellow Belt
02-2023
Team Leader
Integrity Healthcare Solutions PVT LTD.
03.2022 - Current
Six Sigma White Belt
01-2022
Team Leader
Axial Health PVT LTD
06.2021 - 02.2022
Senior Process Associate
I Global KPO Services LLP
06.2020 - 07.2021
Senior Process Associate
Adroit BPO KPO Services LLP
08.2018 - 05.2020
Senior Associate
Fedora Solutions PVT LTD
10.2015 - 08.2018
Bachelor of Commerce - Commerce
J K Ram Collage
03.2013 - 03.2015
H.S.C - Commerce
Boys High Schools
10.2011 - 03.2012
High School Diploma -
Excel Institute of Diploma Studies
04.2009 - 04.2013
K.K.Mori High School
04.2008 - 03.2009