Insurance Project

Madhuri Pawar

Phone # 203-***-****

E-Mail: ************.****@*****.***

Professional Experience:

Sutherland Healthcare Solutions May 2010 – December 2014 Team Lead: June 2012 – December 2014

Create, improve, and redefine existing processes to ensure maximum productivity.

Managed and supervised a project team of 35 members and played a vital role as a counselor/appraiser for 5 staff members in employee performance development plans and performance appraisal reviews.

Achieve project targets, address issues hampering the quality. Take corrective steps; organize training for improvement, coach, and counsel staff.

Own the escalation and resolution process of any project issues that might arise during the duration of the project.

Allocates responsibilities to the Analysts and follow-up constantly to ensure that the project goals and objectives are met.

Work closely with the Onsite support team and keeping them abreast about developments in billing, common errors in charge capturing, coding and mailing of the US Healthcare claims, which result in delayed payments.

Share an excellent relationship with the team and be very approachable Also share a good relationship with the other operations like Business Analysis, Quality, IT team, Onsite staff etc.

Constantly identifying the training needs of the project and ensure that each of the team members is certified in their assigned positions.

Sr. Process Associate April 2011 – May 2012

Team management, work assignment and monitoring.

Strategizing for Account Receivable from the insurances reduction for the client.

Identifying trends in payments by the various insurances like commercial, auto insurance, no fault, reprising as well as government payers and making efforts to improve them by better methods of follow-up.

Assist in Inducting of new members and integrating them into the project team.

Training individuals/team on new procedures, new systems, or remedial training as and when necessary.

Have worked on EPIC, PATCOM, Eagle, Meditech, Invision,

Have audited accounts for team members.

Part Time Trainer

Training the new batches.

Researching and updating information on their modules so that the new employees have updated information on the various aspects of the US health care system.

Maintaining coordination and standardizing information flow from module to module. Process Associate May 2010 - March 2011

Worked on Medicare, Medicaid, HMO, and commercial insurance claims.

Experience working on Workers Compensation claims.

Performed Insurance verification, pre-certification, and pre-authorization.

Research and resolve incorrect payments, EOB rejections, and other issues with outstanding accounts.

Send secondary claims upon processing of primary insurance.

Follow up on Insurance and patient aging. Re-submit insurance claims as necessary. Knowledgeable in timely filing restrictions.

Has been consistent with the Productivity and the Quality for the project.

Has done the Mentoring for the new reps.

Specialized Skills/Knowledge:

In-depth functional knowledge of US HealthCare.

Specialized in Full Business Office on the Provider (Hospital) side which includes Insurance verification, Billing, Accounts Receivable Follow-up, and Transaction Postings.

Knowledge of US Healthcare claims life cycle covering commercial, government, re- pricing or managed care and the bottlenecks at each stage.

Knowledge of US HealthCare philosophy and functioning, the different types of payors, payment mechanisms and systems, types of contracts and contractual terms, kinds of plans and Revenue Generation Cycle.

Strong Data Analysis skills.

Worked on Billing Software.

Excellent knowledge of Computer literacy (Pivot tables, VLOOKUP, MS PowerPoint)

In-depth functional knowledge of US HealthCare.

Specialized in Insurance verification, Accounts Receivable Follow-up, and Transaction Postings.

Insurance & Patient Aging.

Knowledge of US Healthcare claims life cycle covering commercial, government, re-pricing or managed care and the bottlenecks at each stage.

Extensive knowledge of ICD-9, HCPCS, CPT and DRG billing and coding.

Good knowledge of Medical and Surgical terminology.

Knowledge of UB04 and HCFA 1500.

Trained in BASE SAS, SQL.

Education/Training:

Bachelor’s in Biochemistry, Microbiology, Chemistry - Aurora’s Degree College - April 2010

Master’s of Science in Healthcare Administration - May 2016

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