Saurabhh Sharma
Senior Manager-HOD Medical Audit
Faridabad
Summary
To undertake a challenging career, which would give me an opportunity to grow as an individual and acquire the knowledge and ability to contribute to the success of my organization
A confident and an optimistic person with willingness to take initiative and boldly face challenges posed on me.
Overview
14
14
years of professional experience
17
17
years of post-secondary education
2
2
Certifications
3
3
Languages
Work History
Senior Manager-HOD Medical Audit
SSB Superspeciality Hospital
01.2024 - Current
- Audit Credit panels files ECHS,CGHS,TPA,INSURACE to prevent errors and revenue loss.
- Mineralize deductions in Credit files
- Audit Discharge summaries of various credit panels.
- Enhancing revenue through correct billing and minimalise deductions.
Senior Manager-HOD Medical Audit
Ayushman Hospital and Health Services
03.2022 - 03.2024
- Medically audit files and bills of various government credit panels like ECHS,CGHS and TPA and insurance
- To prevent deductions and enhance profitability
- Provided strong leadership to enhance team productivity and morale.
- Consistently met or exceeded annual performance targets set by senior leadershiprevent
Manager-Billing Audit
Metro Group of hospitals
01.2021 - 05.2022
- Auditing bills of Echs,Cghs,TPA,Insurance bills audit to improve billing and prevent deductions
- Handling all units of Metro groups all over india
- Travel and visit metro units .Audit ,discuss and improve issues with unit heads of hospitals
TPA incharge
Venkateshwar hospitals
10.2020 - 01.2021
- Handling all TPA activities
- Replying queries raised by TPA
- Monitor the general functions of the department on a daily basis to ensure that the process and the protocols are being adhered to in the department
- Oversee the discharge process and take all necessary steps to minimize errors in billing during the discharge process
- Escalate and recommend cases for waivers/ resolution to the management for settling the cases
Manager- Recovery
Pristyn Health care
07.2020 - 10.2020
- Responsible for recovery in struct cases
- Working on rejected cases to convert them into payments
- Working on reconcillation and on deductions in approved cases
Head-TPA & Insurance
BLKSuperspecialityHospital
08.2018 - 06.2020
- Deduction Analysis,and check recoverable amount to increase profitability by recovering possible amounts
- Replying queries raised by TPA
- Handling TPA department
- Monitor the general functions of the department on a daily basis to ensure that the process and the protocols are being adhered to in the department
Manager -Corporate Marketing (Business Development)
Grecian Superspeciality Hospital
12.2017 - 03.2018
- Handled Government Business
- Responsible for CGHS business
- Ensured that the monthly revenue targets are achieved in both these verticals
- Doing monthly sales forecasting and reporting on various levels of MIS
- Maintaining and tracking the business from all Government vertical and show growth
- To design and strategize the way forward to building revenue and sustaining it
HEALTH CLAIMS INVESTIGATOR
MAX BUPA HEALTH INSURANCE COMPANY
07.2017 - 12.2017
- Investigation of health claims regarding Pre-existing disease
- Prevention of frauds in the assigned area
- Visiting the hospitals and meeting the treating doctors regarding treatment details
- All round investigation in the fraud claims
- Controlling flow of claims in the assign areas
TPA Doctor
Fortis Escorts Heart Institute
07.2016 - 07.2017
- Ensuring three way matching/audit(patient file vs bills vs billing activity sheets) for all planned discharges and high value /ALOS/ICU patients
- Ensuring floor audits in coordination with nursing/medical audit to ensure accurate patient billing
- Check on room up gradation on daily basis
- Monitoring under or over charging, whether billing is sync with medical treatment
- Coordinating with MRD/nursing/TPA to ensure credit bills dispatched in accordance with MOU with TPA/Corporate/PSU clients
TPA INCHARGE
NAYATI MULTISUPERSPECIALITY HOSPITAL & RESEARCH PVT LTD
04.2016 - 07.2016
- Empanelment of TPA &insurance companies
- Rate negotiations and tie ups with insurance companies
- Following up of payments with insurance companies
- Handling and solving queries of TPA patients
- Liaison with various corporate and government departments with regard to solving queries raised by them and coordinate cases for VIP patients
- Handling all insurance related issues
- Resolving queries raised by insurance companies
TPA COORDINATOR
Fortis Hospital
12.2013 - 04.2016
- Handling hospital TPA Department
- Replying queries raised by TPA
- Oversee the discharge process and take all necessary steps to minimize errors in billing during the discharge process
- Follow for the individual outstanding post discharge
- Present data for the individual outstanding post discharge as and when required
- Recommend cases pre or post discharge for waiver if some error is found in billing or related to any information flow from various related departments
ASISTANT MANAGER (CASHLESS TEAM)
GENINS INDIA TPA
05.2013 - 12.2013
- Giving approvals/Denial- cashless and reimbursement all India cases
- Handling all indiagenins branches for smooth functioning and operations
- Cashless Approvals
- Query Arising
- Reimbursement
- File Processing
SENIOR CLAIMS/NETWORKING EXECUTIVE
STAR HEALTH INSURANCE COMPANY
07.2011 - 05.2013
- Claims investigations of claims
- Reimbursement claims settlement
- Cashless claims settlement
- Empanelment of hospitals in the area
- Resolving networking issues in the area
- Claims team support
- Networking and coordination between company and hospitals
- Audit the quality of services in the hospitals
- Detecting the frauds, cheating, false claims etc
- Infrastructure verification in the hospitals for empanelment
- Resolving issues related to payments
Education
MBA - Hospital Management and Health Care Services
Akshita Institute of Management Studies
Delhi, India04-2014
B.P.T - Physiotherapy
College of Applied Education And Health Sciences
Meerut, India 01.2005 - 01.2009
High School Diploma -
DAV Public School
Vasant Kunj, India 04.2001 -
Skills
Troubleshooting and problem resolution
Strategic planning
Talent development
Operations management
Operations planning
Resource allocation
Certification
MBA in Hospital Management and Health Care Services, 2014, Akshita Institute of Management Studies, Sikkim Manipal University
Personality Profile
A confident and an optimistic person with willingness to take initiative and boldly face challenges posed on me.
Core Competencies
Northern Railway Central Hospital, New Delhi, 10/2009 - 04/2010, Worked as an internee physiotherapist in the department IPD as well as in the OPD including Ward rounds, ICU duty, recovery rooms duty, pediatrics ICU duty, MICU duty, Joint replacement Centre and CCU duty., 3rd & 4th year, 4 months clinical experience at Lala Lajpat Rai Medical College, Meerut., 4 months clinical experience at Vani School for Physically Handicapped, Meerut., 4 months clinical experience at Disha School for Physically Handicapped, Meerut., 4 months clinical experience at Well Equipped College OPD which deals in Ortho, Neuro & Sports Injuries rehabilitation., 4 months clinical experience at Annapurna Hospital, Meerut., After 4th year, 2 months volunteer work at Akshay Pratishthan school of handicapped and mentally challenged, Vasant Kunj, New Delhi., 6 months internship from Northern Railway Central Hospital, New Delhi.
Disclaimer
I hereby inform that all information presented above is true to the best of knowledge and I hereby sign below for the authenticity of the same.
Personal Information
- Father's Name: Late Sh.H.G Sharma
- Date of Birth: 09/27/85
- Gender: Male
- Nationality: Indian
- Marital Status: Married
Timeline
Senior Manager-HOD Medical Audit
SSB Superspeciality Hospital
01.2024 - Current
Senior Manager-HOD Medical Audit
Ayushman Hospital and Health Services
03.2022 - 03.2024
Manager-Billing Audit
Metro Group of hospitals
01.2021 - 05.2022
TPA incharge
Venkateshwar hospitals
10.2020 - 01.2021
Manager- Recovery
Pristyn Health care
07.2020 - 10.2020
Head-TPA & Insurance
BLKSuperspecialityHospital
08.2018 - 06.2020
Manager -Corporate Marketing (Business Development)
Grecian Superspeciality Hospital
12.2017 - 03.2018
HEALTH CLAIMS INVESTIGATOR
MAX BUPA HEALTH INSURANCE COMPANY
07.2017 - 12.2017
TPA Doctor
Fortis Escorts Heart Institute
07.2016 - 07.2017
TPA INCHARGE
NAYATI MULTISUPERSPECIALITY HOSPITAL & RESEARCH PVT LTD
04.2016 - 07.2016
TPA COORDINATOR
Fortis Hospital
12.2013 - 04.2016
ASISTANT MANAGER (CASHLESS TEAM)
GENINS INDIA TPA
05.2013 - 12.2013
SENIOR CLAIMS/NETWORKING EXECUTIVE
STAR HEALTH INSURANCE COMPANY
07.2011 - 05.2013
B.P.T - Physiotherapy
College of Applied Education And Health Sciences
01.2005 - 01.2009
High School Diploma -
DAV Public School
04.2001 -
MBA in Hospital Management and Health Care Services, 2014, Akshita Institute of Management Studies, Sikkim Manipal University
B.P.T (Bachelors Of Physiotherapy), 2005-2009, College of Applied Education and Health Sciences, Chaudhary Charan Singh University, Meerut
MBA - Hospital Management and Health Care Services
Akshita Institute of Management Studies
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