Service Representative Center

Curriculum Vitae

Silpi Sinha Ray ***** Selmer Plaza Philadelphia, PA- 19116 Phone #: 267-***-**** E-mail: ***.*****@*****.***

Objective: To obtain a position where I can bring my multilayer skills and training experiences to support the goal and mission of the employer. Personal Skills: Extensive working experiences on patient services in health care with the following hands-on skillsets but not limited to - 4 years of Insurance verification for benefit through various insurance portal. - Knowledge of insurance guidelines/policies/procedures - Customer care (incoming and outgoing calls) -Keeping medical records and paperwork for medical necessity - Medical scheduling for patients at general clinic and mental health clinic -Provider scheduling as scheduling coordinator - Well experienced with EINTEK, Brightree, Next Gen and GE Centricity software. -excellent written and Oral Communication skill. -working as a team player.

Education: MA (Master of Arts) in English Literature, 2002, University of Burdwan, India

BA (Bachelor of Arts) in English Literature, 2000, University of Burdwan, India

MBA (Master of Business Administration). 2005, Manipal Health Science University, India

Computer Literacy: MS Office, well experienced with Navinet, Brightree, Next Gen and GE Centricity software in Health Care System. Languages Known: English, Hindi (India), Bengali (India & Bangladesh)

Work Experiences:

1.Managed Care Coordinator Merakey Avs - Warminster, PA, May 2022 to Present

registers patients, verifies insurance, issues referrals, and assists practice management with policy/protocol development and training as it pertains to managed care plans.

Maintains up to date knowledge of insurance requirements pertinent to patient service and managed care

Assists practice manager with developing policy and procedures and provides in-services to staff as it pertains to managed care

Updates patient registration in system according to established protocol

• Working with IDD consumers. Interact with physicians, Merakey staff (Nurses, Adaptive Equipment Specialist, Motor Development Specialist, PT, OT, ST, Administrators, etc.), Durable Medical Equipment vendors, pharmacy, etc. to obtain documentation, facilitate billing and coordinate follow-up.

• Communicate with family regarding insurance questions, issues, changes, etc.

• Complete, submit and track all letters of medical necessity, medical exceptions and other documentation, resubmissions, approvals, rejections and billing for physical/medical consults, therapies, durable medical equipment/supplies and other services needed by the individuals and paid for by insurances.

• Coordinate referrals for physician, therapy services, testing and DME needs.

• Coordinate the appeals process on behalf of the physician, as needed.

• Contact area physicians and needed medical services to find those participating in the network.

• Respond to billing inquiries and work with providers, Merakey Fiscal Department and family contacts, as needed, to obtain resolution.

• Maintain current client insurance information by working with Social Services, Fiscal Dept. and family contacts.

• Establish and maintain various file systems, as directed.

• Travel to various Merakey facilities to consult with the physician and Merakey staff to retrieve information from charts, as needed.

• Attend managed care related meetings which minimally includes House Manager, Pharmacy and Therapeutics, Pre-Admission, as well as regular meetings with the Health Services Supervisors to discuss any outstanding issues.

• Respond to insurance inquiries and provides required information and documentation.

• Assist in reconciliation and tracking of Warehouse orders/deliveries and assist in resolving any discrepancies.

• Perform related duties, special assignments and projects as required

2. Verification Researcher Vertical Screen, Inc. - Warminster, PA, January 2022 to May 2022 Verification education and employment history as well as conduct reference interviews conduct research via out bound call, fax, email, internet and online database research.

3. DME Customer Service Representative Rotech Healthcare Inc. - Bensalem, PA, November 2020 to April 2022 Job duties and responsibilities: • Verifies patients’ continuous insurance coverage and financial responsibility.

• Ensures applicable coverage co-payment, and coding rules are met before items are delivered. • Validates insurance allowable against product cost on sales orders. • Inbound call handling service. • Patient Communication Service. • Data Entry • Knowledge of HCPC code. • Knowledge of ICD 10 codes • Applying prior authorization • Research for documentation to continue DME supply • Contact physician's office for renewal of order and to obtaining CMN or necessary paperwork. • Handling reauthorization for oxygen patients. • Contact patient for delivery and making the whole route for day to day delivery.

4. DME Triage Associate Mat's Pharmacy and Medical Supply - Croydon, PA, March 2018 to December 2020 Job duties and responsibilities: • Experience in Bright tree softwares. Handles high volume of inbound and outbound phone calls. • Verifies patients' continuous insurance coverage and financial responsibility via Navinet, PA Access, Bravo, Aetna, Gateway and other insurances. • Verifies prescriptions are correct. Renews expired prescriptions and sends them to physician for refill approval. • Ensures applicable coverage co-payment, and coding rules are met before items are delivered. • Validates insurance allowable against product cost on sales orders. • Correctly identifies doctor's enrollment with Medicare/Medicaid insurance. • Documents all patient interactions in Brightree as progress notes and fulfilling payer requirements for refills. • Completes ICD-10/9 diagnosis codes; confirms ICD-10/9 codes and the patient supply match • Brightree Experience • Understanding Insurance Allowables • Excellent Phone Communication Skills • Customer Focus

5. Patient Service Representative Bright Smiles Dental - Langhorne, PA, December 2017 to January 2018 Job duties and responsibilities: • Performed patient registration and insurance verification. • Set up schedule appointment • Maintained office document 6. Call Center Agent Patient Star LLC Nurse Staffed Call Center Service, June 2012 to December 2012, NJ Job duties and responsibilities: • Inbound call handling service, • Patient Communication Service, • Data Entry, • Taking insurance Information, • Verifying eligibility. 7. Admin. Coordinator University of Minnesota - Minneapolis, MN, September 2010 to October 2011 Job duties and responsibilities: • Participated recruitment processes for stuffs by selecting appropriate CV, scheduling for interview, communicating with the applicant as directed by higher authority. • Provider's schedule editing, Master schedule editing, Making super slot, Freezing & thaw of schedules, Editing hold, Edit in IDX approved request, Switching appointment type, Template creation in GE Centricity Software. • Scheduled day to day operation and workflow for major departments (Primary Health Clinic, Mental Health, Women Health

)

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