SHAIKH SHAKIR AHMED

• Passionate about working cross-functionally, thinking strategically, and keeping our users safe while protecting free speech
• Manage day-to-day Product Compliance Trust & Safety Operations through content moderation and data labeling activities.
• Influence & execute the compliance strategy and drive the operations roadmap with cross-functional teams and drive continuous improvement
• Gather, analyze and utilize relevant data to develop ways to improve the overall Seller experience
• Research and stay up to date on key trends and suspicious patterns across policy areas.
• Participate in on-call emergency escalation rotation as well as after-hours and weekend duty when necessary.
• Excellent compliance subject matter expert for the company, and maintain expertise by regularly performing operational core work, handling escalations and quality audits.

• Strong customer service skills; answering client, patient and carrier calls; prompt return and follow up to all interactions; prompt response to requests for information
• Timely management of unpaid claims as assigned, through the use of the client’s office manager; aging reports; correspondence; Clearinghouse and PM rejections; SharePoint
• Effectively handle complex payer denials; responsible to ensure that secondary claims are sent and paid
• Monitoring and reconciliation of claims
• Timely posting of payments and identifying adjustments and differences in payments
• Knowledgeable of medical EOB’s, patient deductibles and co pays, and insurance or third party correspondence
• Effectively work with clients and group to facilitate information and resolve charge questions
• Capable to create a credit/debit report and denial reports in order to provide critical information to the AR Specialist
• Expert ability to add specific data such as modifiers, payer specific information, including authorization criteria, CPT and ICD-9 code and date of injury (DOI)
• Timely and efficient input and reconciliation of batches
• Work with clients and group to facilitate information and resolve charge questions
• Achieve goal of a 48-hour turnaround batch time
• Complies and enforces and policies and procedures
• Achieve goals set forth by supervisor regarding error-free work, transactions, processes and compliance requirements;
• Other duties as assigned

• Experience in defining the scope and the Testing scenarios for the project.

• Co-ordinating with the stake holders to understand the requirements and plan for execution.

• Extracting and transforming daily reports using MS Excel to assign and access the team performance.

• Implementing new/existing workflow and processes as per client alignment.

• Domain knowledge of healthcare patient accounting and Revenue cycle.

• Submit/Resubmit Claims: Correct and/or appeal denied or rejected claims.

• Checking insurance payment for accuracy and compliance with contractual discount and posting.

• Analyzed claims data to identify trends in denials and rejections.

• Clearing all system generated billing reporting to internal clients
• Finding financial delinquencies and correcting them
• Generating bills and routing them to customers
• Resolving Hill bill queries
• Resolving all billing queries -Handling escalations , dispute and Ombudsman cases within the stipulated time frame.