Medical Insurance
Resume:
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Personal Summary
A highly motivated and ambitious individual, able to support and provided training to team members and individuals. Possessing excellent management skills and having the ability to work with teams. Having a proven ability to lead by example, consistently achieve/exceed targets, improve best practices and organize time efficiently. Areas of Expertise
Follow-up with Insurance companies, Medical Billing & Coding (RCMS), Patient Follow-up, Denial Management, Team Management, Accounts Receivable, Audit, CPC (Medical Coding) and Advanced Excel. WORK EXPERIENCE
Thumbay Group, UAE December 2018 to August 2019
Insurance Coordinator
Responsibilities:
Worked as a Insurance Coordinator for Clinic and Labs BU (Business Unit).
Registering patient’s details in software, coding (ICD-10) and billing accordingly.
Checking member eligibility with insurance through web portal.
Handling and solving patients query via calls (Inbound and Outbound) and mails.
Taking approvals for GP (General Practitioner), Dentist and Labs services through online web portal (E-claim link & DHPO) and mails.
Preparing drugs through OpenJet.
Creating ERX through E-Claims
Answering Client’s query regarding patient’s medical policy and copay.
Communicating with Insurance companies for rejection issue.
Preparing sick leave via DHA Portal.
Optum Healthcare formerly United Health Group, India August 2017 to August 2018 Senior Claims Specialist
Responsibilities:
Worked as a Senior Claims Specialist for Physician BU (Business Unit).
Follow up on the outstanding balance until we receive payment from insurance companies & also work on the Denials and front end rejected claims.
Preparing Appeals for Government & Commercial payers.
Maintained exceptional production & quality as per the process requirement.
Follow up with all commercial insurances along with Government & Commercial payers.
Assigned the work order to the entire team.
Maintained & Prepared MIS reports on team attendance and production of day-to-day report and forwarding to Team Lead & Manager.
Auditing the accounts of the team.
Trained the new hires on the process and provided feedback to them.
Conducting Team Huddle on daily basis.
AGS Healthcare, India January 2016 to August 2016
Senior Claims Analyst
Responsibilities:
Worked as a Senior Process Analyst for Hospital, Physician & Ambulance BU (Business Unit).
Follow up with all commercial insurances along with Government & Commercial payers.
Follow up on the outstanding balance until we receive payment from insurance companies & also work on the Denials and front end rejected claims.
Maintained exceptional production & quality as per the process requirement.
Daily work on Account Receivables and Account Payable (AR/AP) for Hospitals and Clinics across United States of America.
Provide training on process updates & software, Billing and Follow-up (AR/AP) to all new joined employees in process and mentoring them till they go live.
Prepare MIS reports on team attendance and production of day-to-day report and forwarding to team lead and manager.
Sutherland Healthcare Formerly Apollo Health Street, India December 2013 to January 2016 Revenue Cycle Specialist
Responsibilities:
Worked as a Revenue Cycle Specialist for Hospital BU (Business Unit).
Follow up on the outstanding balance until we receive payment from insurance companies & also work on the Denials and front end rejected claims.
Maintained exceptional production & quality as per the process requirement.
Follow up with all commercial insurances along with Medicare, Medicaid, No fault & Worker’s compensation.
Worked on several reports as per the process requirements.
Having knowledge of the entire Revenue Cycle Management (RCM).
Responsibilities of training the new joiner’s and mentoring them till they go live.
Maintaining the track report of day-to-day work for quality check and to keep away the work related issues. MD MANAGE INDIA PVT LTD April 2013 to September 2013 Account Receivable Caller
Responsibilities:
Worked as a Revenue Cycle Specialist for Physician BU (Business Unit).
Major responsibility to monitor the collections/transaction posting.
Speed up collections of claim payments through effective AR follow up.
Co-ordinate with the clients directly on resolving the issues.
Trained fresher’s to get confidence on their work.
Maintaining the track report of day-to-day work for quality check and to keep away the work related issues. Academic Qualification
B.Com from Manav Bharti University in 2016.
Intermediate from Board of Intermediate Education in 2008.
S.S.C from Board of Secondary Education in 2005. Technical Skills
CPC (Medical Coding).
Expert in Advanced Excel with VBA.
MS Office.
Basic Computer Knowledge.
Hardware & Networking.
Hobbies
Playing Cricket.
Playing Football.
Listing To Music.
Personal Details
Name : Mohammed Abdul Sami Rasheed
Father’s Name : Mohammed Abdul Waheed
Marital Status : Single
Nationality : Indian
Languages Known : English, Hindi and Telugu
Date of Birth : 17-03-1989
Visa Status : Residence Visa
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