Contact Address:

Delhi NCR, Modinagar, Shri Shyam

city colony 201204.

Mobile Number: 741*******

E-Mail ID:

adu4c9@r.postjobfree.com

Personal Details:

Date of Birth : 7 November 1992

Sex : Female

Personal Attributes:

• Confident and Determined

• Self-Motivating Personality

• Quick learner

• Spirit to work in a team and

flexible to work on diverse

projects.

• Ability to thrive and strive in

challenging situations

• Strong Communication &

Interpersonal skills.

Languages Known:

• English

• Kannada

• Hindi

CAREER OBJECTIVE:

Being an enthusiastic and hardworking person, I have always been committed to accomplishing my goals with full dedication and utmost sincerity. My efforts and contribution have been well taken and rewarded well by my seniors and fellow colleagues. My focus is to work for the betterment of a company and its related tasks with all zest and to contribute in the field of science and technology in the best of my capacities.

ACADEMICS

Degree Bachelor of Dental Surgery

College

Rajiv Gandhi University of Health Science and

Research Bangalore

Year of passing 2016

Course Higher Secondary School Education

School DAV Public School

Year of passing 2011

Experiences In Companies

• Company: Allstate Insurance from July 2022 to September 2022 Senior Claims summarization analyst Accident cases US claims On contract

• Company: Optum Global Solution (UHG) From-July 2020 to June 2022 Role: Senior Clinical Claims investigator Automobile accident medical claims adjudication US medical claims + adjudication Auditing and quality check Fraud Risk Management

• Company: Vidal Health Insurance TPA From Sept2017 to Oct 2019 Role: Senior Medical Claims Officer- pre-auth Department

&Medical claims adjudication

Dr Kriti Kiran

Internship

• Worked as dental surgeon in SJM DENTAL COLLEGE AND HOSPITAL from July 2015 to October 2016. Work Experiences in Detail

• Total 4.3 years of experience in non-clinical insurance medical field.

• Overseeing the medical care of patients and the surgical& medical treatments performed by doctors &medical staffs.

• Expertise in utilizing medical knowledge of American guidelines, CPT coding, diagnosis codes, and CMS Guidelines, All Modifiers, Bundling of codes, APAC rules, HIPPA and HICFA guidelines

• Handling, Investigating and processing (FWA) fraud, waste and abuse cases for Medicare and Medicaid providers.

• Responsible for coding all medical history, E&M, events, drugs, surgical procedures, indication &laboratories tests.

• Denial and recovery claims verifications and substantiation of the processing on medical grounds and policy terms & conditions.

• Identifying the discrepancies between medical records, upcoding, unbundling, duplication and miss representation of medical services and medical records.

• Skilled in reverting to insurer and insured queries and handling of corporate and brokers escalation.

• Conducting meetings, handling claims quality excel, assisting the prospective team with projects& reporting.

• Sound knowledge of all kind of medical treatment, surgical treatment, diagnostic and therapeutic procedures.

• Mentoring& providing training in team regarding the policy guidelines, denials, achieving daily targets &accuracy

• Investigating, managing the claims &preventing from the over, double or wrong payment to the insured.

• Coordinating & communicating to the providers, hospitals, other departments& insureds regarding claims queries, medical records, payments & Policies terms conditions. Core Competencies

• Attended maxillofacial surgeries in OT.

• Good knowledge of dental surgery and medical treatment.

• Handling of the diagnosis, treatment, and referrals for patients.

• Assisted to the senior dental surgeon in minor OT.

• Good medical diagnosis knowledge.

• Diagnosing the disease as per the symptoms.

• Periodically meeting the patients and observing their improvements and making reports.

• In case of emergency, giving basic treatment to the patients.

• Helping other medical staffs in performing their duties. Awards and Achievements

• Participated in Dahntay Bhagya Yojana for edentulous patients organized by Karnataka government

• Participated multiple rural dental treatment camp. Declaration

I hereby declare that the above written particulars are true to my knowledge.

(Kriti Kiran)

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