POOJA KUNDU

• Verifying Insurance eligibility and benefits
• Handle, manipulate and analyze data and information responsibly
• Working difficult & outstanding physician account balances to resolution
• Working on payer specific website to verify benefits , COB and update the same
• Update patient details correctly as per the service file in the system and remediating errors/issues pertaining to that
• Updating patient responsibility by analysing the data in the system
• Working on authorization denials, checking prior-authorization if applicable with the help of payer specific portal and taking appropriate measures to obtain the same via calls (if needed)
• Maintaining daily target of 40 accounts and over achieving it up to 140
• Understanding of insurance guidelines including the majority of private insurance companies, Medicaid, Medicare, HMO companies, and PPO companies
• Familiarity with ICD-10 and CPT coding

• Guiding the team - Lead the team each day to achieve high levels of performance and customer satisfaction.
• Strengthening relationships - Establish and maintain solid communication with clients and team members
• Understand needs, resolve issues, and exceed expectations.
• Increasing Morale - Ensure effective motivational programs are in place and recognitions are frequently
• Collaborate with team to define business requirements for organizational processes, achieve productivity standards and adhere to quality standards along with proper analysis of complex and aging accounts preventing any payments and escalating them according for proper resolution
• Identified and resolved process issues to drive optimal workflow and business growth.

Promoted as Sr. Process executive with existing responsibilites and goals

• Domain: Healthcare
• Tools: athenaIDX, Connect Back Office, Avaya and MS Office Suite Basics
• Experienced working with UHC, Cigna, Aetna, commercial ,third party, MCR, federal payers
• Working difficult & outstanding physician account balances to resolution
• Trained in hospital billing for few months
• Review of complex or inter-related denials specifically for coding issues and eon analysis for effective outcome
• Maintaining daily target of 40 accounts and over achieving it upto 140%
• US Healthcare Commercial and Managed Care Insurance Claim Management/Billing/Claim Edit Resolution
• Preparing appeal denial letters In regards to specific issues with payer specific appeal form along with proper documentation supporting appeal request followed by timely follow-up
• Understanding of medical terminology that commonly appears on medical claims
• Comprehension and upholding of patient confidentiality laws through HIPAA compliance
• Ability to research policies and identify discrepancies
• Ability to communicate and resolve issues with insurance representatives

• Domain: Inbound Customer Service
• Tools: Avaya and MS Office Suite Basics
• Responsibilities:
• Handling inbound calls
• Generating revenue through customer service
• Mentoring
• Making NBN B2B appointments
• Generating revenue through successful closure of appointments
• Handling irate customers
• Customer Retention
• Meeting Daily, Weekly & Monthly targets
• Helped co-workers understand how to effectively manage Relevance, Productivity and Quality.

• Domain: Inbound Customer service
• Tools: Avaya and MS Office Suite Basics
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• Training & Process -
• Handling Inbound Calls
• Generating revenue through customer service
• Making NBN B2B appointments
• Generating revenue through successful closure of appointments
• Handling irate customers
• Meeting Daily, Weekly & Monthly targets.