Pinky Singh
Assistant Manager
Noida
Summary
I am currently serving as an Assistant Manager in M&R operations, where I lead a team of clinical investigators. With a strong foundation in medical knowledge, I bring a unique perspective to my role, having practiced as a homoeopath and later transitioned into clinical investigation. My expertise lies in preventing the payment of potentially fraudulent and abusive claims by leveraging my medical expertise and thorough understanding of CPT and diagnosis codes. My domain knowledge, rooted in my medical background, enables me to effectively manage and guide my team while ensuring the highest standards of accuracy and compliance.
Overview
14
14
years of professional experience
2010
2010
years of post-secondary education
5
5
Certifications
Work History
Assistant Manager
United Health Group (UHG)
03.2023 - Current
- Lead a team of 25-30 medical graduates, ensuring a safe and legal work environment.
- Manage performance metrics (timeliness, quality, productivity) and appraise job results.
- Plan, monitor, and coach employees; enforce systems, policies, and productivity standards.
- Maintain quality service by resolving issues, identifying trends, and recommending improvements.
- Enhance professional knowledge through workshops, publications, and networking.
- Drive employee engagement and retention by sharing company vision and providing feedback.
- Comply with employment contract terms, company policies, and directives.
Subject Matter Expert
OPTUM global solutions
03.2021 - 03.2023
- Prevent payment of potentially fraudulent and/or abusive claims using medical expertise and knowledge of CPT/diagnosis codes.
- Apply CMC guidelines and client-specific guidelines.
- Understand policy terms, conditions, and various protocols/guidelines.
- Handle claims adjudication and ailment-wise ICD & procedure coding.
- Maintain and ensure standard operating procedures and protocols.
- Manage volumes effectively to maintain turnaround time for processing cases.
- Provide SME support to Clinical M&R Team (resolving queries, knowledge brush-ups, team huddles, RCA of internal/external errors, appeals, and audits).
- Involved in projects such as RPA (PIRPA-281/676/677) - active stakeholder in PRIPA 281 calls and discussions, coordinating with the RPA team, and responsible for signoffs for deployments.
- Identify payment leakages, create process maps, and rectify cases.
Clinical Investigator
OPTUM global solutions
02.2016 - 03.2021
- Implement updates of AMA, AHA, and CMS guidelines; review and analyze medical records to add/modify CPT codes.
- Extract and code screening CPT and HCPCS codes; check NCCI edits and LCD & NCD coverage determinations.
- Organize and prioritize work to ensure compliance with regulatory and client guidelines, and provide team inputs for quality and productivity improvement.
Centre Head
Bakson's Homoeopathic Clinic
10.2011 - 01.2015
- Consult patients with allergic and other diseases, suggesting treatment methodologies as defined by Bakson's.
- Achieve quarterly and monthly sales targets for the center.
- Assign roles and duties to doctors and sub-staff; monitor tasks regularly.
- Train medical staff and interns as needed.
- Maintain the daily cash register in Excel and report to Head Office daily.
- Manage all logistic and in-house issues related to running the center.
Consultant
Shri Balaji Charitable Trust
05.2011 - 09.2011
- To consult patients suffering from various diseases and prescribe medicine as per own discretion & prudence.
Education
BHMS -
Y.P.S.M Homoeopathic Medical College
Alwar, RajasthanXII - undefined
Central Board of Secondary Education (CBSE)
X - undefined
Central Board of Secondary Education (CBSE)
Skills
Operations management
Team leadership
Recruiting and interviewing
Team building
Adaptability and flexibility
Verbal and written communication
Employee supervision
Conflict resolution
Resource allocation
Certification
AMA- CPC
Accomplishments
- Received Venus Award at UHG (May 2015, February 2018).
- Received Sustaining Edge Award for Quarter 3 (2021).
- Achieved sales targets at Bakson's Homoeopathic Clinic:Rs. 11.50 lacs for March Quarter 2014.
Rs. 10.50 lacs for all quarters in 2013.
Rs. 8.50 lacs for all quarters in 2012.
- Secured 3rd position in 2nd & 4th year of B.H.M.S. course at Alwar.
Projects Trainings Internships Certifications
- Voluntary Work: Gynecologist at Sapra Hospital, Alwar, Rajasthan (April 2011 - October 2011)
- Internship: Y.P.S.M Homoeopathic Medical College OPD (May 2010 - April 2011)
- Responsibilities: Managed acute and chronic diseases (skin allergies, gastric, muscular, respiratory ailments, gynecology, pediatric complaints) under senior doctors' supervision
- Project: 'Menopausal Syndrome' thesis during internship (2010-11)
Personal Information
- Date of Birth: 11/29/84
- Gender: Female
- Marital Status: Married
Timeline
AHM- 250
11-2023
New Manager Program
05-2023
Assistant Manager
United Health Group (UHG)
03.2023 - Current
Subject Matter Expert
OPTUM global solutions
03.2021 - 03.2023
AMA- CPC
08-2019
NPS
02-2019
Clinical Investigator
OPTUM global solutions
02.2016 - 03.2021
Centre Head
Bakson's Homoeopathic Clinic
10.2011 - 01.2015
Consultant
Shri Balaji Charitable Trust
05.2011 - 09.2011
XII - undefined
Central Board of Secondary Education (CBSE)
X - undefined
Central Board of Secondary Education (CBSE)
BHMS -
Y.P.S.M Homoeopathic Medical College
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