Sharmila. A

(4.4 Years Experience)

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Healthcare Knowledge: - Claim Adjudication, Claim Adjustment, Claim Rework, RCM and Provider data service.

Job Responsibilities: -

• Ensure timely and accurate adjudication of claims
• Take ownership of all claims processing issues
• Manage all type of investigative activity on major claim
• Establishes claim reserve requirements and makes adjustments, as necessary, during the processing of the claims.
• Extracting all inventory and assigning the claims to entire team.
• Daily interactions with team people regarding the day-to-day work updated.
• Handling the projects and performing Vlookup formula to update the spreadsheet.
• Giving quality support for multiple projects simultaneously.
• Worked towards the reduction of aged tasks by providing assistance to the team and took the challenge in clearing backlogs.
• Exceeded goals through effective prioritization and consistent work ethic.

(3.1 Years Experience)

Job Responsibilities: -

• Analyze and processing the case study -Handling the queries of US health care providers and appealing them regarding their request.
• Resolving the complaints, grievances, and appeals -Reconsidering on basis of provider's requests, sort out the tasks to concerned areas as well as resolving the queries.
• Subgroup head -To meet the team consistent quality and productivity, I took the initiative as SGH and contributed my effort in meeting the client's expectations.
• Internal Auditing - Attending the client's escalations and providing the solutions to overcome from the errors.