Richa Pradipgiri Gonsai
Ahmedabad
Summary
Vast knowledge of medical terminology, procedures and medical billing, with 4+ years of professional experience, also Data entry excellence and proficiency in a wide range of commonly used medical and standard administrative applications and software. Also, independently evaluate explanation of payments for patient accounts and understand correspondence based on knowledge of policy and personal discretion. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Junior Business Correspondence
Jay Engineering Combine Pvt. Ltd. (Compressors & Soap wrapping machine)
2021.10 - Current
- My responsibilities were to Arrange meetings with Buyers and Suppliers, completing vendor's registration formalities, submitting email Price offers, Price negotiations with buyers, submitting online tenders, searching online prospective customers, completing online inspections of the Materials, Submitting required documents to the concerned Government Department, submitting required documents to the logistics companies, sending payment reminders to buyers, submitting sales & purchase details to Accountant office
- Handling Financial matters, arranging business tours & travels, looking after sales & services, handling & managing different manufacturers, attending inquiries of buyers, making payments to suppliers, maintaining overall office work culture.
- Collaborated with cross-functional teams to optimize workflows and drive process improvements.
Senior Process Associate
CrystalVoxx Global LLP (Also Known as Kapil Shailesh Popat)
2017.07 - 2021.09
- Inserting, verifying the patient's demographic details such as name, gender, date of birth, address, current active insurance and other contact information
- Receive and review patient charts and documents for accuracy
- Assessing Clinical information or patient charts, through scanned files such as Patient registration and consent forms, demographic details sheets, medical records and laboratory records which are uploaded to a secure FTP location or by given access to practice management software through secure RDP servers or VPN connections
- Verifying the Medical charts and encode the clinical assessments into the ICD 10 codes
- Translating patient's treatment information into alphanumeric & numeric clinical codes
- Determining the CPT Codes (Current Procedural Terminology) and other HCPCS Codes (Healthcare Common Procedure Coding System), Modifiers and inserting it into the generated charge in PMS
- Always checking for the compatibility of the diagnosis with procedural codes and modifiers, with referring it to Local Medical Review Policy (LMRP) and Local coverage determination (LCD) guidelines, and assign appropriate ICD 10 codes, CPT codes combinations accordingly
- Also, to make sure that if the service performed requires prior authorization
- Eliminating under coding which could result in underpayment or over coding, that increases insurance denials that causes the claims to be reworked in the form of denials
- Hence, ensuring codes are accurate and sequenced correctly in accordance with government and insurance regulations
- Follow up with the provider on any documentation that is insufficient or unclear
- Even communicate with other staff regarding documentation
- Execute coding reconciliation process to confirm precise assignment of all the elements for each patient records which includes review of each billed charge, appended codes, modifiers, service dates, admission dates, referring and rendering provider credentials and are performed scrubbing and also allotted a correct status so that, they are ready for electronic transmission or manual paper mailing to progress the billing cycle
- Analyze the charges and documentation and communicate with the clients if any discrepancies are found or require any clarifications
- Search for information in cases where the coding is complex or unusual
- Also, review the previous day's batch of patient notes for evaluation and coding
- Prepare, review & send patient statements for the balance they have on their accounts
- Identify and resolve insurance contractual obligations (CO) or all other
- Denials and take the corrective actions based on the documentation
- Maintain strict confidentiality about Protected Health Information (PHI) and adhere to all HIPAA guidelines and regulations
- Also, resolve patient billing complaints
- Also, responsible for payment posting, adjustments, according to established guidelines
- Ensure accurate entry of work into designated billing systems
- Independently evaluate explanation of benefits (payments) for patient accounts and understand correspondence based on knowledge of policy and personal discretion
- Downloading file from Drive and uploading It in folders separately, according to the practices
- Communication with the Clients to provide or obtain corrected or additional data
- Performs corrections for patient registration information that includes, but is not limited to, patient demographics and insurance information
- Maintaining responsibility for work processing for assigned individuals to assure that the department is meeting goals
- Perform monthly quality audits as directed by the department supervisor
- Reporting problems and issues to the clients
- Works on special projects set by seniors
- Meet daily standards of productivity as established.
- Maintained accurate documentation of processes, facilitating easy reference for internal audits and knowledge transfer.
Team Mentor
eBay
2015.08 - 2016.11
- At eBay, I was the Team Mentor for Frontend Customer Service Executive providing excellent customer services to the clients and customer for their experience on buying or selling on eBay
- My duties included solving technical glitches, customer queries and helping my team members in resolving the customer query at earliest and following up on the resolution on the customer query
- After sales duties included making daily reports and documenting the targets to the Team Lead for further analysis on the operations.
- Created an open-door policy for team members to address concerns or share ideas, fostering trust within the group.
Customer Care Executive
Aegis Essar Group
2015.04 - 2015.06
- I worked as a Customer Care Executive in Aegis Essar Group of Companies for world's biggest telecommunications network based in UK
- My responsibilities included responding to customers email request, finances, billings and reporting to process upgrades.
- Managed a high volume of inbound calls, multitasking effectively to address diverse customer needs simultaneously.
Head of Training Department
24-7 Fitness
2012.04 - 2014.12
- My primary focus for role of Head of Training was to coach my fitness clients in terms of their physical fitness program adhering to required Diet, Fitness Regime, Cardiovascular Activities, Yoga, Stretch and Mental Stability
- Whilst also was maintaining the Client Records, Company Billings and Corporate Documenting.
- Supported staff members in their daily tasks, reducing workload burden and allowing for increased focus on higher-priority assignments.
Medical Intern
Civil Hospital
2011.06 - 2011.11
- I have worked at Civil Hospital, Ahmedabad as an intern doctor in following departments: - Orthopedics, Neurology, General Surgery, Burn & Plastic surgery, Electrotherapy, T.B Wards, I.C.U, Obstetrics & Gynecology, Pediatrics, Emergency Medicine, Trauma, Geriatrics, Cardiothoracic surgery and Rehabilitation
- My duties included: - direct patient interaction and history taking, conducting physical examination, treating the patients with various exercises in various department and also mentoring undergraduate's students on various topics.
- Demonstrated adaptability by swiftly rotating through multiple departments, broadening clinical skills and expertise across various specialties.
Education
Bachelor of Physiotherapy - Physical Therapy, India
Rajiv Gandhi University of Health And Sciences
Bengaluru, India02.2011
Skills
- CPT, ICD-10-CM, and HCPCS Level II codes
- Standardized classification workflow
- Medical terminology
- Data entry and management
- Speed typing
- Analytical skills
Certification
- Medical Coding CPC (Certified Professional Coder)
- Medical Terminology
- Transcription Skills- Learn Beginning to Advanced Skills
- Certified Electronic Health Records Specialist
- Basic Medical Scribe Training Course
- Revenue Cycle and Healthcare Finance- Rev Cycle Ready
- Records and health Information Management
- Strategies to Maximize Your Health Insurance Benefits
- Tackling the Novel Corona virus (London School of Hygiene and Tropical Medicine)
Disclaimer
I hereby declare that above motioned information is true and correct as per the best of my knowledge.
Timeline
Junior Business Correspondence
Jay Engineering Combine Pvt. Ltd. (Compressors & Soap wrapping machine)
2021.10 - Current
Senior Process Associate
CrystalVoxx Global LLP (Also Known as Kapil Shailesh Popat)
2017.07 - 2021.09
Team Mentor
eBay
2015.08 - 2016.11
Customer Care Executive
Aegis Essar Group
2015.04 - 2015.06
Head of Training Department
24-7 Fitness
2012.04 - 2014.12
Medical Intern
Civil Hospital
2011.06 - 2011.11
Bachelor of Physiotherapy - Physical Therapy, India
Rajiv Gandhi University of Health And Sciences
- Medical Coding CPC (Certified Professional Coder)
- Medical Terminology
- Transcription Skills- Learn Beginning to Advanced Skills
- Certified Electronic Health Records Specialist
- Basic Medical Scribe Training Course
- Revenue Cycle and Healthcare Finance- Rev Cycle Ready
- Records and health Information Management
- Strategies to Maximize Your Health Insurance Benefits
- Tackling the Novel Corona virus (London School of Hygiene and Tropical Medicine)
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