Medical Billing Quality
Resume:
MohamedRiyaz
**, ******* ******, ********, ***** - 636002.
PH # 962-***-****
Mail ID:********@*****.***
Skype ID:MohamedRiyaz151991
To pursue a promising career in an innovative organization where my acquired knowledge and technical skills are put to best use.
Very enthusiastic to learn new concepts and implementation techniques.
Pushpa Matriculation School
S.S.L.C
Salem, TamilNadu
Graduated April 2006
Sri Vidya Mandir higher secondary school
HSC
Salem, TamilNadu Graduated June 2008
K. S. Rangasamy College of Technology
Bachelor's Degree
Tiruchengodu, TamilNadu Graduated May2011
Acusis Software Pvt. Ltd.
Sr. RCM specialist QA
Bengaluru, Karnataka
July 2019 – March 2020
Key Responsibilities as Sr. RCM specialist QA
Currently handling two clinics to stabilize the AR trend.
Creating application to continue the automation process.
Need and exceed Client Metrics: External and Internal Quality metric should be consistently Green
Lead, direct, guide and manage operational excellence and quality team engaged in various aspects of quality control, assurance and operational tasks.
Take complete responsibility of performance on the Quality and SLA/KPI metrics. Drive/identify improvement areas in assigned area/project.
Drive customer impacting projects and bring efficiency and effectiveness.
Be able to collaborate with operations, Training and other stake holders for the better delivery. Develop controls to minimize external and internal escalations.
Overall implementation, planning and improvement of the Transactional Quality Framework
Set up, improve, drive and streamline monitoring, feedback and other internal processes related to Training and Transactional Quality.
Introduce metrics to monitor quality and report to the management on improvements necessary to meet customer and industry standards.
Cerner HealthCare Solution Pvt. Ltd.
Revenue Cycle Audit Specialist
Bengaluru, Karnataka
November 2016 – June 2019
Key Responsibilities as Revenue Cycle Audit Specialist
Handled twenty members of team.
Creating application to continue the automation process.
Need and exceed Client Metrics: External and Internal Quality metric should be consistently Green
Lead, direct, guide and manage operational excellence and quality team engaged in various aspects of quality control, assurance and operational tasks.
Take complete responsibility of performance on the Quality and SLA/KPI metrics. Drive/identify improvement areas in assigned area/project.
Drive customer impacting projects and bring efficiency and effectiveness.
Be able to collaborate with operations, Training and other stake holders for the better delivery. Develop controls to minimize external and internal escalations.
Overall implementation, planning and improvement of the Transactional Quality Framework
Set up, improve, drive and streamline monitoring, feedback and other internal processes related to Training and Transactional Quality.
Introduce metrics to monitor quality and report to the management on improvements necessary to meet customer and industry standards.
Key Responsibilities as Medical billing Specialist
HIPAA Compliance, & Medical Terminology. Good Online Claim Submission.
Excellent Interpersonal Skills. Excellent Phone Skills.
Strong verbal and communication skills.
Claim analysis and solving skills (Analyst mode). Flexible to work in all conditions.
Post and reconcile insurance and patient payments. Research and resolve incorrect payments.
Follow up on Insurance and patient aging. Re-submit insurance claims as necessary Knowledgeable in timely filing restrictions.
Hinduja Global Solution Pvt. Ltd
Claim Processing Executive
Bengaluru, Karnataka
March 2013 – October 2016
Key Responsibilities as Executive Trainer
Conducting training for the new hires (From Basic U.S Healthcare to current update for the project).
Tracking the Quality % of existing associate.
Coaching on the topics and denial for the existing associate.
Conducting Brainstorming session for the fellow Trainers.
Managing of HIPAA Compliance Database and Training for HGS.
Key Responsibilities as Claim Processing Executive
Responsible to adjudicate insurance claims for U.S Health Care under the platform of Citrix.
Processing (ACAS) Medical, Hospital, Accident &Vision claims (U.S).
Working on Team performance.
Working as positive individual and an integral member of a team.
Addressing issues regarding performance of team.
Mentoring to the new hires
Performing quality check for the claims processed.
Achieved the “Best QA” award for the month of March’18.
Selected for New Pilot Project (Accumulator Adjustment).
Handled Special Projects on behalf of the Team.
Got appreciation mails from the clients.
Achieved night on the Town award for Automation.
1.Sports – Cricket & Indoor Games
2.Hobbies – Drawing, Reading & Listening to Music
Microsoft (Excel, Advanced excel, Word, PowerPoint &Visio)
Software PHP, SQL, C, C# and .net
Operating System Windows, Linux and Ubuntu
Work with operations by supporting Operational Excellence initiatives.
Excellence in ATB Analysis and Strategy planning.
Employee Development, Mentoring, Leadership.
DOB : 01/05/1991
Age : 27
Gender : Male
Marital Status : Single
English, Tami, Urdu, Hindi (Read, Write &Speak)
Kannada (Speak)
I hereby declare that the information furnished above is true to the best of my knowledge and belief.
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