Usha Mandyani

Key Responsibilities

• Prepare and submit clean claims to insurance companies in a timely, accurate manner.
• Ensure all required patient, provider, and procedure information is correctly entered and compliant with payer-specific guidelines.
• Use EPIC software as an electronic health record (EHR) and billing software to process claims, verifying CPT/ICD-10 codes for accuracy and compliance.
• Collaborate with coding teams to resolve discrepancies and ensure appropriate documentation for services rendered.
• Track and monitor the status of submitted claims to ensure they are processed and paid within expected timeframes.
• Proactively reach out to payers via phone, portals, or electronic clearinghouses to check on delayed or unpaid claims.
• Escalate unresolved issues to supervisors or submit appeal as needed, to ensure maximum reimbursement.
• Analyze claim denials and rejections to determine root causes, such as incorrect coding, missing documentation, or eligibility issues.
• Correct and resubmit denied claims promptly, following payer-specific guidelines and timelines.
• Coordinate with medical coders, providers, and insurance representatives to resolve complex denials.
• Document denial trends, and report findings to the supervisor to support process improvements and training initiatives.
• Accurately collect and verify patient demographic, insurance, and financial information during registration.
• Confirm insurance eligibility and benefits prior to services being rendered, ensuring pre-authorizations, and referrals are obtained.
• Maintain compliance with privacy regulations (HIPAA) while handling patient data.
• Prepare and maintain consolidated production files to track and report team performance metrics regularly, aiding transparency and process improvement.
• Handle client emails and inquiries in the absence of the Supervisor, ensuring timely and professional communication with stakeholders.
• Support new joiners during on-the-job training and act as a go-to resource for team members, answering queries and providing clarification on workflow processes.
• Take initiative to allocate and distribute daily tasks to team members in the absence of the Supervisor, ensuring balanced workloads and timely completion of deliverables.
• Proactively engaged in internal training sessions, including Email Etiquette, Stress Management, and Feedback Handling, demonstrating a commitment to personal and professional growth.
• Received three R&R Awards (2 Monthly + 1 Quarterly) for highest production, recognizing outstanding performance and consistency.
• Maintained 100% quality with zero errors in claim processing, contributing to a highly efficient and audit-ready workflow.