Salman Khan
SME (Subject Matter Expert)
Jaipur
Summary
- Results-oriented and detail-focused Claims Representative with extensive experience in reviewing, processing, and resolving insurance claims. Skilled in assessing claims for accuracy, verifying coverage, investigating discrepancies, and ensuring timely reimbursement. Proficient in working with insurance providers, healthcare professionals, and clients to resolve issues and clarify claim details. Adept at managing denied or unpaid claims, processing payments, and ensuring compliance with regulatory standards like HIPAA. Strong communicator with a commitment to providing excellent customer service, improving claim resolution efficiency, and ensuring customer satisfaction.
Overview
9
9
years of professional experience
Work History
Subject Matter Expert
Knack Global Pvt Ltd
09.2022 - Current
- Review and analyze accounts to identify discrepancies.
- Review provider claims that have not been paid by insurance companies.
- Escalate difficult collection situations to management in a timely manner.
- Contact insurance companies and patients to follow up on outstanding claims.
- Handle denied/ Unpaid Claims and escalate unresolved cases.
- Maintain compliance with HIPPA and call Quality standards.
- Achieve daily/weekly Productivity targets.
- Collaborate with the billing team to resolve issues and expedite payments.
- Maintain accurate transaction records.
- Stay updated on healthcare billing regulations and procedures.
- Provide excellent customer service to clients and insurance representatives.
Senior Account Receivable
Omega Healthcare Pvt Ltd
09.2021 - 09.2022
- Convince the claims company (payers) for payment of their outstanding claims.
- To check the appropriateness of the insurance information given by the patient if it is inadequate or unclear.
- Send reminders and statements regarding overdue payments.
- Resolve and billing discrepancies and ensure accurate account reconciliation.
- Collaborate with internal teams to address customer inquiries and resolve issues promptly.
- Assist in preparing reports on accounts receivable status and aging.
Senior Account Receivable
Isys Softech Pvt Ltd
01.2017 - 04.2021
- Conduct thorough reviews and in-depth analysis of patient accounts to identify billing discrepancies, posting errors, or missing information affecting claim resolution.
- Examine outstanding claims and assess reasons for non-payment by insurance companies, ensuring timely and accurate follow-up procedures.
- Proactively escalate complex or unresolved collection cases to management, adhering to escalation protocols and minimizing delays in resolution.
- Initiate and maintain effective communication with insurance companies and patients to follow up on unpaid or underpaid claims, ensuring all necessary documentation is submitted.
- Manage denied and unpaid claims by analyzing Explanation of Benefits (EOBs), correcting billing errors, and resubmitting claims as appropriate; escalate persistent denials for further review.
- Adhere strictly to HIPAA regulations and internal call quality standards while handling sensitive patient information during claim resolution and follow-ups.
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Education
Master of Science - Computer Science
Jaipur National University
Jaipur 04.2001 -
Bachelor of Science - Computer Science
Rajasthan University
Jaipur, India 04.2001 -
High School Diploma -
Sent Sonam Sr, Sec, School
Jaipur 04.2001 -
Skills
- Medical Claims Processing
- Health Insurance Policies & Procedures
- ICD-10, CPT, and HCPCS Coding (basic familiarity)
- Claims Adjudication
- HIPAA Compliance
- Electronic Health Records (EHR) Systems
- Microsoft Office Suite (Excel, Word, Outlook)
- Claims Review & Validation
- Error Detection and Discrepancy Resolution
- Eligibility and Coverage Verification
- Explanation of Benefits (EOB) Analysis
- Investigative Research
- Patient and Provider Communication
- Dispute and Denial Resolution
- Conflict Resolution
- Record Keeping & Documentation
- Multitasking in High-Volume Environments
- Time Management and Prioritization
- Meeting Daily/Weekly Processing Targets
Timeline
Subject Matter Expert
Knack Global Pvt Ltd
09.2022 - Current
Senior Account Receivable
Omega Healthcare Pvt Ltd
09.2021 - 09.2022
Senior Account Receivable
Isys Softech Pvt Ltd
01.2017 - 04.2021
Master of Science - Computer Science
Jaipur National University
04.2001 -
Bachelor of Science - Computer Science
Rajasthan University
04.2001 -
High School Diploma -
Sent Sonam Sr, Sec, School
04.2001 -
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