Ranjeet Singh
Kalyan
Summary
Proficient healthcare team player with solid understanding of interdisciplinary healthcare standards. Specializing in Medicaid and Medicare LOBs and bringing 7 years of experience in industry. Excellent recordkeeping, problem-solving and multitasking skills.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Associate, UHG A&G
Wipro Ltd
Airoli
10.2016 - 10.2020
- Responsible for management of the Pre-authorization and Post-authorization request received from the Members,Member-Rep & Providers.
- To complete the request with in SLA provided by the client.
- Ensuring that the request is handle correctly. and been reviewed properly for further processing.
- To identify the urgency, requester, department, pre-authorization or post-authorization.
- Help the requester to get approval of the denied pre-auth and post-service to get their medicines.
- Assurance of all the data that been processed is correct, For e.g, Member information, urgency, TAT, requester, request type and denials.
- Members Eligibility (Member with end-stage renal disease, HIV, Cancer) or should be 65 or above.
- Create case for each and every member for their denials of drugs or approval of claims.
- Follow the guidance of SOPs.
- Be ready for client initiated projects.
Quality Assurance Analyst, HealthFirst
Wipro Ltd
Airoli
10.2020 - 03.2023
- Worked with team members to create efficient workflows, resulting in high productivity.
- Assisted other members of the QA team in identifying areas for improvement in processes and procedures.
- Maintained policy, procedures, work instructions, and projects for quality and continuous improvement agendas.
- Recommended improvements to systems and procedures for increased productivity.
- Ensure all the information updated in the case by processor is correct and been sent to the correct department.
- Provide FYIs,Error and feedback by attaching quality report to each cases.
- Audit the cases and verify all the criteria's provided by the client should be reviewed.
- Identification of type of request whether it is grievance, inquiry, pre-authorization or post-authorization. Also, verify whether the correct grievance category is selected based on the grievance, correct authorization taken or claim number taken.
- Whether the case is routed to correct department or not.
- To achieve quality and production target set by the client.
Provider Data Specialist, Cigna Corporate Services
Wipro Ltd
Airoli
04.2023 - Current
- Management of data of the providers.
- Verifying provider credentials with cigna and third parties.
- Providing assistance to team members regarding the use of REN Modules and process knowledge related to provider data management.
- Assurance of new providers added into the system, as well as those removed or updated.
- Providing support to the team members in terms of process knowledge and production issues.
- Utilized various databases and tools to validate provider information such as licenses, certifications, education details, hospital affiliations.
- Always need to be updated regarding the changes in process.
- Maintained up-to-date records of all providers in the system, including contact information and qualifications, service locations, billing locations and mailing locations.
- Maintained up-to-date records on contracts relations of the provider with the association & business entity. Also, Fees schedule for the different specialties of the provider.
- Based on the market of the United states the process may varies. Certain procedure needs to be followed for different states.
- Reviewed provider data submissions to ensure accuracy and completeness of information.
- Detected and resolved data quality issues and discrepancies for integrity and quality control.
- Updating of data in the provider's records as per request of the provider. Data such as Demographics Domain, Contracts, Network & Re-imbursement.
- Ensure that all the production and quality parameters should be met which is set by the client.
Education
B.Com - Commerce
RKT College
Ulhasnagar04-2016
High School - Commerce
SDT Kalani College
Ulhasnagar03-2016
Skills
- HIPAA Compliance
- Microsoft Excel
- Data Management
- Data Validation
- Medicaid Knowledge
- Adaptability and Flexibility
- Analytical Skills
- Organizational Skills
- Problem-Solving Aptitude
- Attention to Detail
- Team Collaboration
- Problem-Solving
- Adaptability
- Goal Setting
- Multitasking
- Active Listening
- Decision-Making
- Relationship Building
- Time Management
- Teamwork and Collaboration
- Task Prioritization
- Problem-Solving Abilities
- Self Motivation
- Reliability
- Team Building
Accomplishments
- Trail Blazer Award x2
- Best Sqaudmate Runner-Up x1
Certification
- CCC
Affiliations
- Gaming
- 3D Modeling
- Photoshop
Timeline
Provider Data Specialist, Cigna Corporate Services
Wipro Ltd
04.2023 - Current
Quality Assurance Analyst, HealthFirst
Wipro Ltd
10.2020 - 03.2023
Associate, UHG A&G
Wipro Ltd
10.2016 - 10.2020
B.Com - Commerce
RKT College
High School - Commerce
SDT Kalani College
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