Shrreya Gupta

• Handled the full scope of RCM activities related to Anthem Payer's enrollment and maintenance tasks.
• Facilitated project management by outlining key components.
• Verified proper consent acquisition before releasing medical data.
• Implemented quality improvement objectives fostering better performance outcomes.
• Develop effective business solutions through coordination with WFM, Sales, and Transition groups.
• Handled customer escalations effectively, ensuring satisfactory resolutions.
• Manage adherence to established service levels and turnaround times.
• Designed and integrated macros into workflows, reducing manual interventions and boosting efficiency.
• Created two macros in collaboration with the team to streamline processes and enhance accuracy.
• Worked jointly with client to update standard operating procedures for improved workflow efficiency.
• Produced thorough, accurate and timely reports of project activities.
• Provided regular reports to senior management on team performance, challenges, and strategic recommendations.
• Proposed or approved modifications to project plans.
• Delegated work to staff, setting priorities and goals.
• Held regular one-on-one meetings with employees to review performance and priorities and provide feedback.
• Conducted root causes analysis to develop corrective action plans.
• Provided technical assistance when needed.

• Managing RCM operations for claims submission and insurance follow-up.
• HIPAA-certified medical biller for U.S. healthcare with knowledge of CMS-1500 and their process orientation, HIPAA/EDI.
• Managing new projects by defining scopes, timelines, SLAs, team structure, governance, and solution approach with clients.
• Responding to inquiries for the release of medical information, ensuring that legal requirements are followed, and proper consent has been obtained.
• Leading a team of analysts by defining KRAs, along with established department policies, procedures, and continuous quality improvement objectives.
• Providing multiple services to clients through Medical Billing Research, RCM, Virtual Assistance, Client Management, Data Analysis, Project Execution, and MIS Management.
• Ensuring defined SLAs are met.
• Responsibilities include working in RCM functions such as EOB review, payment posting, correspondence review, bad debt, appeals process, denial management, and account receivables.

• Serve as Medical Biller for healthcare providers.
• Medical Biller for Medicaid, Medicare, and Commercial Payers.
• Medical claims management, knowledge of CMS 1500 claims, and their process orientation, HIPAA/EDI.
• Identify, prioritize, and resolve the issue for the claim to be in the scrubber.
• Developed SOP to facilitate seamless process execution.

Work according to:

• Primary insurance's Explanation of Benefits (EOB) is to bill secondary insurance with the correct information and resolve the edit.
• Determine patient eligibility status.
• Fix edits related to the missing information in the first claim form, which got stuck in the scrubber.
• Rebill the rejected claims with correct, accurate information.
• Create an encounter based on patients' data and services through the charge entry process.
• Support month-end financial reconciliation.
• Gather data for monthly reporting.
• Assists new colleagues in understanding the tools and work of the medical biller.
• Have knowledge of and work on denial Level 1.

Tools used and knowledge of:

• Cirius scrubber, Icentra, Epremis, Epic.

• Identified new sales opportunities via inbound lead follow-ups and outbound cold calls.
• Assessed client necessities for successful completion.
• Identified crucial figures in accounts to generate interest.
• Analyzed customer feedback and provided insights into areas of improvement for existing products and services.
• Increased company profit through effective employee training.
• Enhanced and updated records of potential clients in specified region.
• Collaborated with channel partners to develop sales pipeline.

• Managed large-scale events focusing on brand awareness, event promotion, and coordination.
• Crafted branding advertisement campaigns.
• Used strong verbal and written communication skills to convey messages to others.
• Generated leads and boosted client engagement through telecalling efforts.
• Completed daily administrative tasks such as filing documents, recording data and processing paperwork.
• Developed capabilities of volunteers through targeted efforts.
• Event Promotion & Coordination-Sanskar Shala, Sangini, Samvaadi, Jagran Film Festival