Claims executive
Pentacare Medical Services
Total years of experience :15 years, 9 Months
• Processing of claim forms, reimbursement claims, adjudicating for provision of deductibles, co-pays, co insurance maximums and provider settlements& reimbursements
• Performing audit of randomly selected claims to ensure quality processing.
• Following adjudication policies and procedures to make sure proper payment of claims.
• Resolving problems resulting from claim settlement.
• Checking for claim coverage and validity & reviewing and assessing claims submitted by patients to ensure that they were indeed covered for a medical procedure by the said insurance company.
• Reconciliation of claims and solving the queries related to them and rectifying them if needed.
• Authenticating the information on all medical claims received.
• Capability of communicating to members and providers in timely and polite manner.
• Substancial knowledge of medical terminology.
• Clear understanding of PBM claims.
• Review of each claim in the file for accuracy and completeness.
• Answering enquiries from providers on the subject of claim, eligibility, covered benefits and approval status issues.
• Second-in-line of Team Leader and handling all the responsibilities adeptly in her absence
• Managing smooth administration of the hospital to deliver good quality and timely in-patient services on a daily basis.
• Planning and scheduling work assignments, performing administrative tasks while creating and sustaining a dynamic environment that fosters development opportunities and motivates high performance amongst team members.
• Developing and maintaining good relationship with the consultants and staff members.Identifying areas of improvement while working in coordination with other departments and effectively improve the performance of the team consistently.
• Responsible for duties as Dental Surgeon including patient care, oral examination, appointment scheduling, patient education, operative care (pre and post), equipment sterilization, diagnostic radiographs and emergency treatment.
• Carrying out diagnostic & therapeutic procedures; monitoring progress of patientsand maintaining record of each patient's progress. Maintaining quality, safety, infection control standards & standards for delivery of dental surgical care, diagnosis & treatment planning.
• Accountable for maintaining Health Record, processing and mounting radiographs, digital radiographs & infection control.
• Developing and implementing quality initiatives to improve the quality of the medical services, diagnostic and treatment facilities, and protocols for exemplary patient care; while ensuring adherence to stringent quality specifications as per the norms of the medical service.
• Ascertaining that quality health services are provided at the best possible levels through the optimum usage of available resources.Using clear, objective guidelines for evaluation, appraisals and interacted with other administrators.
• Identifying skilled resources in the department and changing their roles/providing additional training to them as per the requirement.Organizing regular periodic meetings & trainings for staff to discuss current work related issues and devise solutions for enhanced operations.
• Providing quality teaching while taking classes for the students of MBA in Healthcare and Hospital Administration.
• Identifying areas of improvement while providing paramedical education to students and effectively coach them to improve their performance consistently. Significantly enhancing classroom learning environment and acting as a facilitator to promote student leadership in initiating and creating positive learning opportunities.
• Conducting Medical and Dental camps on a frequent basis for various Schools and ensuring high quality Health and Dental check ups for the attendees.
• Responsible for pre and post treatment of patients maintaining quality, safety, infection control standards for delivery of dental surgical care, diagnosis & treatment plan.Administered skillfully relevant dosage and non-pharmaceutical, patient care aids with proper prescription of dosages and instructions to patients on their correct usage.
• Carried out Oral Examination, Patient Education, Pre and Post-Operative Care, Appointment Scheduling, Instrument Sterilization, Diagnostic X-Rays, Emergency Treatment, Health Record Management and Oral Surgery and Extractions.
• Efficiently handledtherapeutic procedures viz., Casts and Impressions, Oral Hygiene and Plaque Control, Teeth Whitening, Easy-Dental, Network Infection Control, Preventive Care, Sealant Application, Oral Surgery and Extractions.
• Took patient histories, conducted dental examinations, and recorded the data in the patient's record; wrote progress notes and discharge summaries; prepared patient workups & summaries noting pertinent positive and negative findings.
Managed classroom coverage of assigned subjects as per academic curriculum to students. Conducted practicals for the students. Formulated syllabus and made it available to students after getting it approved along with learning objectives
•Prepared and developed content after conducting proper research on the related topics while ensuring adherence to precision, accuracy and comprehensiveness of coverage. Devised lessons and updated course content, which captured the students’ imaginations infusing much needed enthusiasm.
•Acted as a counselor to the dental students and advised them for their professional and personal developments while resolving and counseling them on their grievances and issues
•Formulated syllabus and make it available to students after getting it approved along with learning objectives
•Collaborated with fellow lecturers on lesson plans and perform administrative tasks viz. recording attendance, managing student portfolios and providing individual assistance to the students.
Responsible for pre and post treatment of patients maintaining quality, safety, infection control standards for delivery of dental surgical care, diagnosis & treatment plan.Administered skillfully relevant dosage and non-pharmaceutical, patient care aids with proper prescription of dosages and instructions to patients on their correct usage.
•Carried out Oral Examination, Patient Education, Pre and Post-Operative Care, Appointment Scheduling, Instrument Sterilization, Diagnostic X-Rays, Emergency Treatment, Health Record Management and Oral Surgery and Extractions.
•Efficiently handledtherapeutic procedures viz., Casts and Impressions, Oral Hygiene and Plaque Control, Teeth Whitening, Easy-Dental, Network Infection Control, Preventive Care, Sealant Application, Oral Surgery and Extractions.
•Took patient histories, conducted dental examinations, and recorded the data in the patient's record; wrote progress notes and discharge summaries; prepared patient workups & summaries noting pertinent positive and negative findings.
Pentacare Medical Services, a TPA in medical insurance.
Responsible for processing medical claims for the individuals and assuring proper payment in keeping the insurance benefit plan;Responsible for processingclaims, overpayment audits, Recovery of money, claims adjustment, reimbursement claims, maintaining logs, detecting potential frauds in claims processing, Reconciliation of claims.
•Over 7 yearsin Hospital Administration &Management, Paramedical Education, Dental Practice and Patient Management across various Preventative, Cosmetic and Restorative Needs, Dental Health Monitoring, Diagnose and Treat Dental Injuries, Diseases and Deformities; previously working as Hospital Administrator & Dental Surgeon with Satyakiran Healthcare, Sonepat; Head of the Department of Satyakiran Paramedical Institute and Academic Coordinator& Senior Faculty with HealinSatyakiran.
•In-depth knowledge of information and techniques needed to diagnose and treat dental injuries, diseases, and deformities including symptoms, treatment alternatives, drug properties & interactions, and preventive health-care measures. Expertise in identifying issues, forming hypothesis, designing & conducting analysis, synthesizing conclusions into recommendations & implementing change.
in Hospital
in Hospital