Renu Gattani advfzw@r.postjobfree.com

Aubrey, TX 918-***-****

KEY SKILLS AND COMPETENCIES

• Excellent Written, Verbal,

Interpersonal Communication

Skills

• Motivational and Leadership

Skills

• Excellent time management

• Effective problem solver

• Requires minimal supervision

• Cross-functional teamwork

• Quick Learner

• Fee Schedule management or

physicians and diagnostic Clinical

Laboratories

• Credentialing Management

• Clean Claim Management

• Billing and Coding Specialist

• Expert in Modifier Usage

• Appeals, A/R Denial Management

• Accounts Receivable/Collections

• Written and Managed SOP for

insurance department

• Proficient in outlook, MS Office,

and Excel

• Billing Software’: Medisoft,

Lytec, and Sydamed

• Uniflow Claim Management

• E-Bridge Claim Management

• Sage Intacct (Accounting

Software)

• MUE (Medically Unlikely Edits)

I am a precise, meticulous, self-disciplined medical billing and credentialing professional with 25 years of experience in outpatient/inpatient, physician practice and diagnostic clinical lab seeking an opportunity as Medical Management specialist. Specializes in managing credentialing, clean claim submission, A/R denials, appeals, and soft collection from patients. Additional expertise includes new practice setup, managing insurance contracts, administrative and management services to enhance the productivity of the practices.

EXPERIENCE

RealTime Laboratories, Lewisville, Texas June 2021-Present RealTime (RTL) is a 10M USD yearly revenue company and provider of the most accurate Mycotoxin tests, both Clinical and Environmental, in the United States as well as International. Billing and Credentialing Specialist

• Manage patient insurance coverage verification using online tools such as Novitasphere (Medicare), Availity (BCBS, Aetna and Humana), Link (United Healthcare) and Humana Military (Tricare).

• Medicare provider eligibility verification through CMS online.

• Clean claims submission using Intacct, lab management system Uniflow, and billing management software E-Bridge.

• Manage remittance posting daily in accounting software (Sage Intacct).

• Collaborate on all aspects of supporting services for organization, including medical billing consultants, Client Services, Laboratory Accessioning and Sales.

• Analysis and manage reimbursement rates for Medicare, Tricare, and commercial insurance in compliance with MUEs and published rate at CMS and insurance portals.

Standard Operating Procedures

• Developed several SOPs for insurance billing department with clear instructions and lots of visuals on how to retrieve patient information to submit clean claims to billing department. Audits and Reconciliation

• Communicate Audit reports of discrepancies between accounting and billing software to upper management through written reports and oral presentations.

• Reconciled money received with account information. Credentialing

• Manage Medicare credentialing through PECOS.

• Manage credentialing with Humana, Aetna, Medicaid of Texas, Medicaid of Oregon, and Multi Plan. Training within the Department and Across the Organization

• Train new hires on patient eligibility verification and claim submission to Medicare, Tricare, and Commercial Insurance.

• Crosstrain co-workers from different department on insurance claim filing process. Lead of Event and Cultural Committee

• Organized an event a month to enhance and cultivate a fun and positive team culture for the organization. Key Accomplishments

• Credentialed RTL with

BCBS of TX

CareFirstMD

• Managed and maintained Mycotoxin claims submission.

Worked on a month-long backlog of Mycotoxin claims submission and turned around time to 24 hours submission.

• Created SOP for insurance department. and maintained SOP from other departments in the organization.

Medicare, Tricare, and Commercial Mycotoxin claim submission.

Maintained SOP from other departments in the organization.

Medicare remittance posting in accounting software (Sage Intacct) Remote Work Experience: Helped all the practices listed below with practice setup, Credentialing, Coding, Clean Claim Management, Payment Posting, A/R Denial management, Cash Collection, and Administrative Services. Molecular MD, Tulsa, OK (Molecular Radiology) Aug. 2016-June 2021 Sooner Trauma Critical Care LLC Wichita, KS (ER Medicine) May 2007-April 2020 Wichita Critical Care LLC, Wichita, KS (ER Medicine) May 2007-May 2011 Surgical Specialists LLC, Wichita, KS (ER Medicine) May 2007-May 2010 In Office Work Experience:

Heartland Surgery LLC, Wichita KS (Vascular and General Surgery) March 2003-December 2004 Ravinder K Rustagi MD PA (Internal Medicine, Cardiology) February 1990-December 1994 New Practice Set Up

• Developed a roadmap for new physicians to start from ground up and managed their practice uninterrupted.

• Obtained group and individual NPI for New Practices, credentialed using CAQH, Medicare, PPO, HMO, and other commercial insurances.

• Managed Credentialing for solo and group practices. Coding and Clean Claim Submission Management

• Managed 100% clean claim submission through accurate patient information, diagnosis codes, CPT codes, and appropriate modifiers.

• Followed timely filing guidelines to file primary, secondary and tertiary insurance claims to maximize reimbursement resulting in no claim loss.

• Managed and updated Fee-Schedule as per CMS, PFS (physician fee schedule). Payment Posting/A/R Denial/Cash Collection Management

• Posted payment both electronically and manually as required.

• Daily reconciliation of insurance and patient payments.

• A/R denial management by ensuring 100% collection on claims by appealing disputed claims and A/R denial management in <60 days.

• Reduced bad debts and increased cash flow by rigorous but courteous follow up on outstanding patient invoices. Management/Administrative Services

• Managed and trained interns on the dynamics of billing, coding, A/R denials, collection process and established relationship with patients.

• Improved process to ensure efficient patient flow through the medical office from check-in to check-out with emphasis on the mission, vision, values, and patient satisfaction.

• Obtained and managed pre-authorization, referrals, lab results while collaborating with insurance companies to manage claims processes.

Key Accomplishments

• Successfully set up practices from ground up.

• Credentialed with CAQH, Medicare, Medicaid, HMO, PPO, and other commercial insurances companies.

• 100% insurance collection

• Soft collection from patients

• Trained new hires to run the office efficiently and effectively Education

BBA (Minor in Marketing), Wichita State University, Wichita KS, 1997 (Magna Cum Laude) ICD-10 Course, Tulsa Technology College, Tulsa, OK 2015 Awards and Recognitions

Team player award-2021 (Realtime Laboratories, Inc.) Employee of the month-October 2022 (Realtime Laboratories, Inc.) Volunteering

BaylorScott&White (Dallas, TX) - Year 2019: Managed OR waiting lounge. Indian Association of Wichita (KS) - 1995-2009: Among many volunteering activities, organized and managed fund-raising event to build playground on temple premises.

Indian Association of Tulsa (OK) - 2009-2017: Led many events to raise funds for the community to help different charities.

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