Insurance Medical

Sangeetha Citore

*** **** ***, ** *****

***************@*****.***

Phone # 815-***-****

Objective:

. Seeking a demanding position as a Reimbursement specialist with the

obtained organizational and professional expertise contributing to the

company's growth.

Skills:

. Highly Analytical thinking with demonstrated talent for identifying,

scrutinizing, improving and streamlining complex work processes.

. Flexible team player that thrives in environments requiring ability to

effectively prioritizes and juggles multiple concurrent projects.

. Goal-driven leader who maintains a productive climate and confidently

motivates, mobilizes, and coaches employees to meet high performance

standards.

. Results -driven achiever with exemplary planning and organizational

skills, along with a high degree of detail orientation.

. Dependable, responsible contributor with committed to excellence and

success.

. Enthusiastic and knowledge-hungry learner eager to meet challenges and

quickly assimilate new concepts.

Professional Experience:

Reimbursement Specialist, Genentech, December 2009 to Present.

. Investigation and documentation of the benefits.

. Initiating the Prior Authorization before services were provided.

. Expert at finding trends and working on EOB.

. Researching for payer specific data.

. Experienced working with public and private payers.

. Utilizing resources such as Google and gathering the benefit details of

the patient.

. Submission and Follow up on Claims to Medicare, Medicaid and Commercial

payers.

. Expert at tracking and posting the payment details.

. Have Good working knowledge on EOB.

. Grouping the patients having same payers and investigating the benefits

on one call. Thus skipping the long holds time.

. Demonstrated team coordination skills.

Insurance Verifier, Last employer, HMS, May 2009 to August 2009.

. Making calls to verify the Insurance details.

. Worked on Different Online Websites such as Emdeon, Availity, Bcbs, Aetna

etc.

. Worked on a project called Well point.

. Expert with the tool called E CARE, client specific.

. Generating calls to Insurance to know the Status.

. Did Electronic Billing of Claims in both the projects.

Associate Analyst, Deloitte Consulting, April 2002 to August 2007.

. Researching the Medical Insurance Claims for US Client.

. Generating calls to Insurance to know the appropriate Status.

. Following up on Payments and Denials from the Insurances.

. Posting the Status obtained from the Insurance on Client system and CMS.

. Expert at Medicare part A and B, Medicaid and Workers Compensation

Claims. Electronic Billing of the Claims- CMS-1500 and UB-92 Forms.

. Well Versed at CPT and HCPC Codes.

. Have Good Knowledge and Understanding of EOB, HCFA, and UB04 Forms.

. Reading Medical Records.

. Finding Trends and get the Claim to Resolution.

Education:

. Pursuing PhD in Health care from Trivalley University, California.

. MBA in Health care from International Technological University,

California.

. B.Sc in Microbiology from St.Francis College For Women, India.

Certification:

. An Oracle Certified Professional (OCP).

. An Oracle Certified Associate (OCA).

. Awarded as Best Social Service Volunteer.

. Experienced Data Analyst / Modeler.

. Microsoft Word - Advanced.

. Languages - C, C++, SQL, PL/SQL.

. Packages - Skilled in MS Word, MS Excel, MS Power Point-Advanced.

. OS - Knowledge of Windows 2000/XP/Vista/Macintosh-Advanced.

. Hard Worker, Self-Motivated, Active Listener.

Contact this candidate