Customer Service Insurance
Resume:
Hiral Patel
Email: *************@*****.***
Cell: 334-***-****
Career Highlights
*Selected for TX Austin Start Up Project at D&Y for TEAM Health.
*Being a Best Credential coordinator got an opportunity to train other credentialing team member and share my best practices with them at D&Y for TEAM Health
*Fixed various claim errors and re-filed with insurance on timely manner so do not lose payments
*Rigorous follow up on past due accounts decreased numbers of collection account
*Assisted office manager in clearing backlog without affecting work flow
*Initiated change in the process resulted in increased customer satisfaction by 25% to 30% nationally
*Reduced customer/patient response time from 200 Seconds to 110 seconds
*Designed and implemented Continuous Quality Improvement (CQI) resulted in increase in overall quality performance
*Received Best Team Performance Award by Reliance Communications
*Received Best Customer Service Award & Sam's Award by Walmart Inc
Work Experience
Credential Coordinator
ID Care, PA – Feb 2018 to Present
*Applying and renewing license like Medical license, CDS, DEA for Doctors, APNs and PAs, sharing licenses copy with all affiliated facilities, insurances including updating CAQH profile.
*Provider Enrollment with all contracted ID care insurance carriers by regularly updating CAQH profile, web based and paper application and PE with MDC through PECOS.
*To ensure that all necessary licenses and credentials are verified and updated for the healthcare facility in which they work. This might include conducting background checks, contacting licensing boards, reviewing license applications, obtaining education information, obtaining malpractice insurance information etc. * Strong research skills to gather pertinent information regarding healthcare facilities.
*Leads, coordinates and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
*Auditing paperwork such as applications and licensing documentation for accuracy.
*Ensures integrity of all paper and electronic practitioner files in accordance with medical staff bylaws, policies and procedures.
*Prepares and distributes facility application to the clinicians.
*Facilitates telephonic / WebEx walk through of facility application with clinician.
*Reviews and ensures the quality of returned facility applications.
*Interacts directly with clinicians to correct applications errors and omissions.
*Follows up and obtains O/S verifications, references, and other items pertaining to privileging on behalf of the MSO throughout the privileging process.
*Ongoing interactions with medical staff office to determine MSO review.
*Notifies relevant parties of "Privileged" status.
*Keeping track of privilege dates and ensuring to start reappointment process on timely manner
*Planning and executing activities relating to reappointments with both MSO's and Clinician.
Credential Coordinator
Co Partnered with TEAM Health April 2017 to Feb 2018
Daniel & Yeager Locums tenens Co Partnered with TEAM Health
*On base of performance got an opportunity to train coworkers and new joiners including sharing best practices.
*Very familiar with all tabs of Teamworks.
*To ensure that all necessary licenses and credentials are verified and updated for the healthcare facility in which they work. This might include conducting background checks, contacting licensing boards, reviewing license applications, obtaining education information, obtaining malpractice insurance information etc. * Strong research skills to gather pertinent information regarding healthcare facilities.
*Leads, coordinates and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
*Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.
*Provided quality analysis and oversight.
*Auditing paperwork such as applications and licensing documentation for accuracy.
*Ensures integrity of all paper and electronic practitioner files in accordance with medical staff bylaws, policies and procedures.
*Work closely with Clinician Onboarding Liaison and recruiter.
*Prepares and distributes facility application to the clinicians.
*Facilitates telephonic / WebEx walk through of facility application with clinician.
*Reviews and ensures the quality of returned facility applications.
*Interacts directly with clinicians to correct applications errors and omissions.
*Follows up and obtains O/S verifications, references, and other items pertaining to privileging on behalf of the MSO throughout the privileging process.
*Ongoing interactions with medical staff office to determine MSO review.
*Notifies relevant parties of "Privileged" status and updates Team Health systems with all necessary information.
*Updating Teamworks and Axess with all data.
Medical Biller and Credentialing Coordinator
Houston, TX
June 2013 to March 2017
*Leads, coordinates and monitors the review and analysis of practitioner applications and accompanying documents.
*Planning and executing activities relating to reappointments with both MSO's and Clinician.
*Ongoing interactions with medical staff office to determine MSO review.
*Follows up and obtains O/S verifications, references, and other items pertaining to privileging on behalf of the MSOthroughout the privileging process. * Provided quality analysis and oversight.
*Insurance verification for office visit patient and collected PT responsibility upfront
*Posted Insurance and Patient Payment
*Resolved claim denied by the insurance and Re-submitting them
*Audited doctors SNF work, fixed errors and filed with insurance on timely manner
*Filed hospital claims by researching doctors progress notes, hospital records and fixed errors* Handled Billing Statements and Collection process for Patients account.
*Filed home health claims with insurance
*Access to various Online Insurance website to verify Patient Insurance
*Access to various hospital websites to check on records pertaining to claim
*Tracked Insurance payment for refiled and denied claims
*Calling various insurance to check on patient benefits & eligibilities, for claim status and claim corrections.
*Scheduled Patient for office visit
*Sent appeal request to MDD
*Tracked vaccination inventory and matched with claims and progress notes
*Mailed and faxed requested medical records
*Tracked payments for 360 and HMR, fixed errors and followed up with insurance
*Tracked payment for case rate claims
*Updated database for Death certificates on state website for doctor's certifications
*Scanned received checks and match with deposit slip
Department Head
GVK EMRI - 108 Ambulatory Services - Ahmedabad, Gujarat
March 2010 to August 2011 India
*Managed Service Level Agreements for ERC Operations to provide uninterrupted services.
*Performance management, conducted weekly reviews and formulated Action Plans with the Team Leaders
*Designed and Implemented CQI for Continuous Improvement (CQI Projects) to improve quality of services,
Response Time and Ineffective caller
*Forecasting, Planning and Scheduling for error free essential services
*Representing Sense department's state performance in Business Review Meeting
*Initiated process to track ambulance efficiency to reduce response time
*Analyzed off road / on road ambulance data to improve on response time
*Managed employee transfers and promotion within and inter-department
Assistant Manager
Reliance Communications - Mumbai, Maharashtra
August 2003 to February 2010
India
*Provided supervision for the overall business operation process in terms of customer focus, cost focus, and peoplefocus.
*Performance management, conducting weekly reviews and formulating action plans with the team leaders.
*Initiated employee motivation program
*Initiated Process implementation of pilot project for Gold Category Customer
*Initiated refresher training and employee development training
*Designed and Implemented process to improve C-sat and FTR (Process and people related), and made changes inprocess at national Level
*Supervised employee scheduling, absenteeism and leaves to be more cost effective
Education
Post Graduate Diploma in Business Administration in Business Administration
Symbiosis Institute of Business Management - Pune, Maharashtra
January 2007
Bachelor of Business Administration in Business Administration
Som Lalit Institute of Business Administration - Ahmedabad, Gujarat
May 2001
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