Summary
Overview
Work History
Skills
Certification
Timeline
Generic

Sonal Prakash

Lucknow

Summary

Results-driven and detail-oriented Medical Claims Audit Officer with experience in conducting audits, reviewing medical claims for accuracy and compliance, and identifying discrepancies. Seeking a challenging role where I can utilize my skills to ensure the integrity of claims processing. I seek challenging opportunities where I can fully use my skills for the success of the organization.

Overview

5
5
years of professional experience
1
1
Certification

Work History

Medical Officer

Mediassist
Lucknow
09.2023 - Current

-Review and process insurance claims for accuracy and completeness

-Verify policy information and coverage to determine claim eligibility

- Investigate and resolve discrepancies in claims to prevent delays in processing

-Perform audits on medical claims to verify accuracy, completeness, and compliance with regulatory requirements

-Develop audit reports and recommendations for process improvement and compliance enhancement - Ensure compliance with insurance regulations and company policies - Meet productivity and quality standards for claims processing

Consultant

Care Healthcare Insurance
Gurgaon
12.2022 - 09.2023
  • Processed dental and medical insurance claims, including verifying patient information, treatment codes, and coverage details - Reviewed and corrected claim errors, discrepancies, and rejections to ensure timely payment
  • Assisted claims processors with data entry, documentation, and file maintenance
  • Communicated with customers and external partners to gather information and resolve issues

Junior Dentist

Roots Dental Clinic
02.2020 - 11.2022
  • Creating a medicinal prescription after studying the symptoms
  • Administrating patients with medicines
  • Understanding allergic reactions from mixing medicines
  • Diagnosing health/oral problems.

Internship

Chandra Dental College and Hospital
01.2019 - 01.2020
  • Creating a treatment plan to maintain or restore oral Health of Patients
  • Ensuring the safe administration of anesthesia
  • Good diagnostic skills using clinical knowledge and x-rays.

Skills

  • Coordinated care activities with other professionals to ensure that the plan is integrated with the treatment plan
  • Diagnoses dental problems in adult and pediatric patients Performs dental prophylaxis (teeth cleaning)
  • Make root canals in lieu of teeth extractions Prescribes medications for patients
  • Worked with clinical staff to improve standards of practice and procedures
  • Educated patients about health maintenance and disease prevention
  • Stay in constant contact with medical facilities providing service to determine accuracy of claims being made
  • In-depth knowledge of medical terminology useful in reading medical reports and determining coverage
  • Processing of Cashless Requests & Health Insurance Claim Documents
  • Maintaining & Ensuring Standard Operating Procedures & Protocols
  • VIP Claims Processing and TAT Maintenance

Certification

  • Certification in Medical Terminology 101 in 2024
  • Certification in Medical Coding CPC training CPC in 2024
  • Certification in Records and Health Information Management in 2024
  • Certification in Anatomy and Pathology required for medical coding Training in 2024

Timeline

Medical Officer

Mediassist
09.2023 - Current

Consultant

Care Healthcare Insurance
12.2022 - 09.2023

Junior Dentist

Roots Dental Clinic
02.2020 - 11.2022

Internship

Chandra Dental College and Hospital
01.2019 - 01.2020
  • Certification in Medical Terminology 101 in 2024
  • Certification in Medical Coding CPC training CPC in 2024
  • Certification in Records and Health Information Management in 2024
  • Certification in Anatomy and Pathology required for medical coding Training in 2024
Sonal Prakash