Mohammed Basarat Pasha
Hyderabad
Summary
Overall 15 years of experience in the BPO Industry. Relevant 10+ years of experience in US healthcare for long term care processing. Understands the Medicare / Medicaid processing. Strong leader and problem-solver dedicated to streamlining operations to decrease costs and promote organizational efficiency. Uses independent decision-making skills and sound judgment to positively impact company success.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Manager BPO Operations - Claims Examination/Adjudicator
DST Worldwide services
Hyderabad
04.2015 - 01.2023
- Handles Insurance claims processing (Medicare / Medicaid / Private insurance bills) for aged people who are unable to perform their daily activities
- The bills will be received for Home Health Care Invoice / Facility invoices
- Handles 25 team members of two different projects related to claims examination / adjudication
- Maintains day to day client SLA’s and meeting their expectations
- And also making sure transactions are processed timely within Turnaround time (TAT)
- Working closely with Onshore partners related to any escalations / important updates / meetings (daily / biweekly / monthly) and discussing the improvement of the quality and productivity of the transactions
- Also share the daily report with client and the team members regarding the transactions processed for the day / weekly report / monthly report (MTD)
- To make sure all the team members achieve their goals for the month
- Monthly meetings with the team members about their quality / productivity
- And educate on the area where improvement is required and make sure they improve in that area
- Also take care of reviewing the daily errors and sending them for rebuttal to improve the quality of the transaction
- Reviewing and updating the documentation (Training Bulletin / Practice Standards) related to claims processing of Medicare / Medicaid / Private Insurance bills (Home Health Care / Facility Bills / Durable Medical Equipment)
- Also take care of training for the new hires for the projects and make sure they get trained on all the processing areas
- Daily huddles with the team members to understand / plan the work for the day and meet / exceed the expectations for the day
- Also take care of preparing the incentive plan for the both teams and appreciate the team members who get nominated and achieved
- Sharing daily productivity / quality reports with the team
- Works on the areas where the team is receiving more escalation from the client on claim processing and making sure Error review sessions are being conducted within the team
- Making sure all the team members are adhering to compliance (HIPAA Health insurance portability and accountability act)
- Takes care of all the specialist task activities apart from the management activities
- Works on the claims which has high dollar authorities (more than 30k payment invoices)
Sr. Claims Associate: Claims Adjudication
Optum Global Solutions
Hyderabad
03.2013 - 04.2015
- Process claims that route out of automatic adjudication within current turnaround standards with efficient productivity and Quality measurements
- Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims
- Analyze and identify trends and provide reports as necessary.
- Followed up with customers on unresolved issues.
- Analyzed and addressed escalated claims to resolve issues quickly.
Sr. Process Executive: Claims Examination/Claims A
DST Worldwide services
Hyderabad
09.2010 - 03.2013
- Managing daily service delivery from End to End point of view
- The Process involves verifying supporting documents like Provider License, Plan of Care, Daily Visit Notes, Continued Monthly Rent (CMR), HCFA, UB/92 and others
- As a specialist received authority to examine claims up to $9000/claim for approvals and denials $15000 within a span of 6 months
- Authorized to do Examination QA(Quality Audit)
Quality Assurance Executive
First Indian Corporation Private Limited
Hyderabad
05.2006 - 06.2008
- Quality checking of database on integrated mainframe system that delivers property ownership and history, tax assessment & payment data recorded document images using Data Trace System
- Daily preparing Exceptional Reports while on Quality Check
- Upgrading of database using Netterm & Exceptional Reports
- Providing Scan Response for the Data Processing Executives & other executives daily
- Daily Interaction with the Processing Executives, Verifiers & other Executives regarding the new amendments.
Education
B.Com - Commerce
Dr. B.R. Ambedkar Open University
Hyderabad, Telangana06-2009
Skills
- Performance Management
- Performance Evaluations
- Team Leadership
- Staff Training and Development
- Complex Problem-Solving
- Time Management
Certification
- CBQA (Certified BPO Quality Analyst)
- Six Sigma Green Belt
Accomplishments
- Awarded Star of the month for the month of October 2015.
- Part of pilot batch for new client (New York Life Claims Examination)
- Got three Star Award for the month of September 2013, February & March 2014.
- Got two Venus Star Award for the month of July 2013 & January 2014.
- Promoted to Quality Team for excellent performance.
- Awarded for excellent quality and exceeding the targets of the process.
- Awarded as star of the month for July, October & December 2011.
- Collaborated with team of 25 in the development of Claims Examination Project.
- As a process executive proven as Best performer in the team consistently for 5 months.
- IPQA (Internal Process Quality Assurance)
Languages
Hindi
First Language
Telugu
Upper Intermediate (B2)
B2
English
Advanced (C1)
C1
Timeline
Manager BPO Operations - Claims Examination/Adjudicator
DST Worldwide services
04.2015 - 01.2023
Sr. Claims Associate: Claims Adjudication
Optum Global Solutions
03.2013 - 04.2015
Sr. Process Executive: Claims Examination/Claims A
DST Worldwide services
09.2010 - 03.2013
Quality Assurance Executive
First Indian Corporation Private Limited
05.2006 - 06.2008
B.Com - Commerce
Dr. B.R. Ambedkar Open University
- CBQA (Certified BPO Quality Analyst)
- Six Sigma Green Belt
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