Experienced and dedicated pharmacy professional with four years of hands on experience in healthcare administration and medical insurance. Proficient in all aspects of insurance claims processing and healthcare coordination. Demonstrates a unique blend of technical expertise ,analytical acumen and interpersonal skills to effectively manage medical claims and ensure data security. Proven tract records of efficiently managing claims workflows, ensuring compliance with regulatory standards and delivering exceptional results. Known for delivering exceptional service,resolving complex issues and driving process improvement. Proficiency in utilizing software systems for data entry and claims adjudication. Possess advance knowledge of medical terminology and pharmacology .A collaborative team player with excellent communication skills and interpersonal abilities.
Responsible for medi-claims handling including verifying insurance policy coverage and making sure client information is accurate. Analyzing insurance information, performing data entry, handling insurance claims reimbursements, and deciding whether a claim should be processed or denied.
Efficiently processed insurance claims for accuracy and compliance with company policies and industry regulations.
Reviewed documentation, verified information and resolved discrepancies to ensure timely and accurate processing.
Contributed to process improvement initiatives, identifying areas for optimization and implementing solutions to enhance efficiency.
Compiled concise and accurate summarization of medical records including patient histories, diagnoses, treatment and outcomes. Reviewed and analyzed medical documentation to extract relevant information and highlight key findings for easy reference. Organized and categorized medical data in specific codes to established guidelines and standards. Utilized IWS to streamline summarization process and maintain consistency and accuracy.
Demonstrated proficiency in medical terminology, coding system and regulatory requirements, facilitating effective communication and compliance with industry standards
Provided compassionate and supportive counseling to patient and their families. Conducted thorough assessments through medical records and developed individualized care plans tailored to each patient's needs and goals , fostering a collaborative and empowering environment .
Offered guidance and education on coping strategies, self care techniques, and resources to enhance patient being and resilience.
SAS Certified: Base SAS
FDA Drug safety understanding
Analytical skills :attention to details
Software proficiency
Compliance knowledge: understanding of insurance regulations and compliance and compliance retirements
Regulatory knowledge of Insurance,understanding insurance laws, policy provisions
Clinical skills and clinical knowledge
Medical Knowledge ,aware of medical terminologies
Diagnosing the disease