Satish R
Delhi
Summary
Adept at navigating complex medical billing landscapes, I leveraged my expertise in Medicaid, Medicare, and Having 13+ years of experience in US healthcare environment demonstrating strong clerical management skills and noteworthy insurance knowledge. Possess track record of submitting accurate claims in timely manner along with exceptional customer relations skills. Passionate about overseeing tasks from start to finish and developing clerical workers into top-performing employees. consistently exceeded departmental goals by maintaining a 99% quality rating in claims resolution.
Overview
15
15
years of professional experience
Work History
Senior Medical Billing Specialist
AspenLake Medical Equipment
Delhi
01.2021 - Current
- Working on Wheelchair, Walker, Cane, Hospitals beds and Commode
- Using Niko Healthcare application and Brightree (DME/HME)
- Search with Patient insurance number and DOB in application
- Search for Inpatient date of discharge in Medicare CGs application
- Analysis all the HCPC codes and ICD 10 as per Patient summary form
- Checking the Delivery date of Wheelchair and Commode
- Coding ICD 10 properly in Niko Healthcare application and save accordingly
- Notes in comments Nikon application with Date of discharge and checking in CMS1500
- Address changes and Insurance changes finding and updating
- Using proper HCPCS codes in Wheelchair K0005 purchase and rental K0004, K0003
- Paying rental wheelchair monthly
- In CGS checking 5 years of history equipment and find put denied the claim
- In CGS Using Jurisdiction C and Jurisdiction B process claims for specific geographic area
- Save in Nikon database and submit the claim
- Rental wheelchair 13 moths checking as per date wise and approving the claim
- If document is missing, mailing to marker or checking in Parachute application to find the Face to face mobility
- Finding out reason like Muscle weakness and history of fall, not able to walk ICD codes M62.81, R26.2, R53,R26.8
Sr. Associate
CapGemini SE
05.2019 - 10.2020
- CDT Dental Claims, Optometry billing claims, Inpatient and Outpatient, ICU (Intensive care)
- Handling cases like AD (Accident Claims), Dental claims, HP (Hospital Indemnity Claims), WLB- Wellness benefits claims, Cancer claims, and Dental claims
- Assessed approved and denied various medical claims requests received
- Computed all medical benefits due and assisted with payment initiations
- Achieved the highest number of inspection appointments (out of 50 colleagues) in 2020
- Surpassed goal by averaging 800 appointments monthly
- Selected by supervisor to assist with file closures; resolve complex claims-processing issues; participate in quality-control audits; and monitor status updates
- Maintained a superior quality rating of 99% in file handling and claims resolution, exceedingly the departmental goal
- Provided optimum service to policyholders, negotiated fair settlements, and identified fraudulent claims
Project Associate
HOD.life
01.2017 - 11.2018
- Complete Body Profile Instant Health Check plus as per package
- Like Kidney Profile, Liver Profile, Thyroid Function Test, Pancreas Profile, Lipid Profile, Iron Deficiency, Vitamin Profile
- Most technological advances in healthcare are towards treating illnesses, rather than preventing them
- Even Medical colleges focus their curriculum on 'treating patients' and 'curing disease', neglecting human behavior
- Health on Demand was built on the principle that prevention supersedes cure
- Assisting the General Manager at Operational Level in the planning and execution of all work-related
- Ensuring that all Health & Safety guidelines and procedures are maintained and implemented
- Proactively building, developing, and maintaining relationships with all team members
- Disciplining employees when required
- Identifying team training needs
- Assisting in the recruitment, training, and development of team
- Supporting and other members of the team with Health check of different packages as per company standees
- Using all accurate devices of Health check-up related and sample collection and all
Sr. Processor
Optimal Chain behalf of SC Horizon Pvt Ltd
NCR Delhi
09.2014 - 05.2017
- Handled all kinds of insurance claims, including Medicare and Medicaid, PPO insurance completed insurance and other claims forms protected patients' healthiness information for privacy
- Maintain patient records, develop, and implement billing policies and procedures, prepare, and submit medical claims electronically
- Communicate effectively with patient for financial options including dental insurance coverage and out of pocket expenses
- Offering payment plan options manage the daily weekly, and monthly calendar to meet the practice production and collection goals
- Performs necessary duties associated with checking patients in and out
- Record treatment information in the patient's chart
- Schedule all future treatment planned for next appointment, and the amount of chair time, doctor time and assistant time needed
- Organize and run daily morning huddle, reports on production results addresses and evaluate patient flow from previous day
- Update staff on the status of the current day's production goals
- Schedule and register New Patients and ensure all required documentation is completed by patient (Welcome letter, HIPPA compliance, Insurance details, Patient information)
Remote Processor
Real Page India Pvt Ltd
Hyderabad
12.2012 - 08.2014
- Reviewed client's insurance policies to determine correctness and eligibility, ensuring the delivery of process updates on daily basis
- Reviewed electronic claims and processes data as required into the claims system, resolved computer generated correct conditions, and determined right payment
- Researched and practice claim payment adjustments resulting from consumer service referrals, audited data incorrectness as detected
- Exercised excellent judgment, interpreted claim insurance data and contracts processes responses accordingly
- Achieved joint effort, production, and value standards to guarantee timely, well-organized, and accurate claim processing
Claims Associate
United Health Group
Hyderabad
07.2010 - 05.2012
- Medicaid and Medicare, UB-04, and CMS-1500 electronically claim forms
- Accurately evaluate, regulate, and pass judgment of Medicare and Medicaid claims in a timely manner
- Ensured to process assigned claim forms and inspect allocation of co-pays, deductibles, reimbursements, and co-insurance
- Enter check over claims into system, Dental expenses, Transit, Parking, Vision expenses
- Researched and analyzed claim over payments and funds requirements
- Maintain patient records, develop, and implement billing policies and procedures, prepare, and submit medical claims electronically
- Handled all kinds of insurance claims, including Medicare and Medicaid, PPO insurance completed insurance and other claims forms protected patients' healthiness information for privacy
Education
Bachelor's - commerce
Wesley Degree College
Hyderabad01.2009
Intermediate -
Word and Deed Jr College
01.2004
School Secondary Education -
Word And Deed High School
01.2002
Masters - MA And Master in Healthcare Administration (MHA)
Online
Skills
- Medicaid
- Medicare
- UB-04
- CMS-1500
- FSA
- HSA
- HRA
- Cobra
- CDT Dental claims
- Inpatient claims
- Outpatient claims
- Surgeries
- ICU claims
- ICD
- CPT
- Claims Adjudication
- Billing
- Denial management
- Certified Professional Coder
- CSM
- Certified Scrum Master
- JIRA
- Project Management
- DME
- Durable Medical Equipment
- Wheelchair
- Walker
- Commode
- Hospital bed
- Cane
Hobbies and Interests
- Playing Basketball (National Basket Ball player)
- Playing music instruments like Guitar, keyboard, and Drumming.
Achievements And Recognition
- Awarded for Best Quality processor
- Achieving excellent production and Quality in claims
- Awarded for Best Hyderabad team in HOD. Life India
- Awarded for best team for Hyderabad from Onshore Client in UHG
- Real page awarded outstanding processor for maintaining high production and Quality with 99% percentage.
Timeline
Senior Medical Billing Specialist
AspenLake Medical Equipment
01.2021 - Current
Sr. Associate
CapGemini SE
05.2019 - 10.2020
Project Associate
HOD.life
01.2017 - 11.2018
Sr. Processor
Optimal Chain behalf of SC Horizon Pvt Ltd
09.2014 - 05.2017
Remote Processor
Real Page India Pvt Ltd
12.2012 - 08.2014
Claims Associate
United Health Group
07.2010 - 05.2012
Bachelor's - commerce
Wesley Degree College
Intermediate -
Word and Deed Jr College
School Secondary Education -
Word And Deed High School
Masters - MA And Master in Healthcare Administration (MHA)
Online
Similar Profiles
Zied RomdhaneZied Romdhane
Sales&Service Engineer at Almofadaly Medical Equipment-Fresenius Medical CareSales&Service Engineer at Almofadaly Medical Equipment-Fresenius Medical Care
Amisai RiveraAmisai Rivera
Customer Experience & Proposal Specialist at Mercy Medical Equipment CompanyCustomer Experience & Proposal Specialist at Mercy Medical Equipment Company
Cynthia JacksonCynthia Jackson
Sales, Business Development and Client Relations at Medical Equipment SourceSales, Business Development and Client Relations at Medical Equipment Source
VAIBHAV KUMAR KAUSHIKVAIBHAV KUMAR KAUSHIK
Deputy Branch Manager at Yes BankDeputy Branch Manager at Yes Bank
Suraj SethSuraj Seth
Automation Test Engineer at Tata Consultancy Services LtdAutomation Test Engineer at Tata Consultancy Services Ltd