Amarta Bharwani

• Review and adjudicate out-of-network payment disputes in accordance with IDRE and federal guidelines
• Analyze documentation submitted by providers and health plans
• Select and justify payment determinations between proposed offers
• Ensure accurate, timely documentation and data entry in government portals
• Collaborate with internal teams, partners, and clients to meet quality and productivity metrics
• Maintain confidentiality, compliance, and professionalism at all times
• Contribute to continuous quality improvement initiatives

• Provider Liaison to Clearinghouse for submission/retrieval issues and opportunities.
• Provider System and Website Access to new/current employees as designated and maintain monthly access reviews.
• Communicate with Insurance Carriers/Clearinghouse efficiently to resolve claim/provider issues. Analyze and troubleshoot EDI related productions issues for rapid resolution to prevent the delay of claims payments.
• Recognize and research claim format (UB04/CMS1500) issues using Implementation Guide/ANSIX12 Electronic Billing.
• Generate and present monthly reports with financial and billing support team to review issues, resolutions, and opportunities.
• Facilitates required documentation collection from providers and group practices to maintain enrollment and/or process new enrollments.
• Accurately reconciled 85+ professional aging claims daily with commercial, workers compensation, auto, hospice and government carriers.
• Thoroughly trained and deployed new staff members to the team and provided team support. System Training and System Upgrade deployment for new groups obtained/purchased.
• Recognized and resolved large claim volume issues and trends with carriers/clearinghouse.
• Manual Posting Payment and EFT/ERA issue tracking/resolution.
• Denials research and resolution including Claim Coding Error Corrections.

• Facilitates required documentation collection from providers and group practices to maintain enrollment and/or process new enrollments.
• Accurately reconciled 85+ professional aging claims daily with commercial, workers compensation, auto, hospice and government carriers.
• Thoroughly trained and deployed new staff members to the team and provided team support. System Training and System Upgrade deployment for new groups obtained/purchased.
• Recognized and resolved large claim volume issues and trends with carriers/clearinghouses.
• Manual Posting Payment and EFT/ERA issue tracking/resolution.
• Denials research and resolution including Claim Coding Error Corrections.
• Provider Liaison to Clearinghouse for submission/retrieval issues and opportunities.
• Provider System and Website Access to new/current employees as designated and maintain monthly access reviews.
• Communicate with Insurance Carriers/Clearinghouse efficiently to resolve claim/provider issues. Analyze and troubleshoot EDI related productions issues for rapid resolution to prevent the delay of claims payments.
• Recognize and research claim format (UB04/CMS1500) issues using Implementation Guide/ANSIX12 Electronic Billing.
• Generate and present monthly reports with financial and billing support team to review issues, resolutions, and opportunities.

• Maintained high level of confidentiality in compliance with HIPPA regulations.
• Met productivity and accuracy standards established by CMS (Center for Medicare and Medicaid Services) and the customer.
• Obtain and maintain credentials to abstract in number of modules, as determined by the Management.
• Knowledge and Experience in AJCC staging.
• Maintained the ability to read and process large amounts of information with extreme attention to detail, while interpreting pertinent information.
• Consistently exceeded productivity and accuracy standards established by the customer, CMS, and CDAC with scores at or above 100% of the module average.
• Validated and abstracted extremely large medical records received (5,000+ pages) without affecting my overall productivity rating in order to meet CMS deadlines.

• Help identify problems with clinical trial start-up and management. Assist with organized improvement efforts and developing research study design improvements.
• Works with department supervisor/manager to assist and train new hires in the research department/across all specialties.
• Works directly with faculty to design and improve data collection efforts. Manages all data collection.
• Work with the Principal Investigator (PI) to develop and update study protocols, including the development of new measures.
• Assist in background research for the proposed quality improvement projects and support toolkit development for hospitals.

• Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
• Guarded against fraud and abuse by verifying coded data accurately reflected services provided.
• Oversee daily Billing Department functions, including medical coding, charge entry, claims, payment posting, and reimbursement management.
• Examine patients' encounter forms to verify diagnosis codes and reconcile codes against services rendered.
• Accurately input procedure and diagnosis codes into billing software to generate invoices.
• Used electronic charge capture practices such as billing and account receivables (BAR) system and medical billing clearinghouse accounts to submit codes and invoices on time.
• Follow up on past due invoices and delinquent accounts to reduce number of unpaid and outstanding balances.
• Document patient data and medical records and perform routine medical record audits to comply with insurance company requirements.
• Uphold and reinforce compliance with hospital policies and federal regulations such as HIPAA.

• Worked as a part of recruiting team in different capacities during the Onboarding process.
• Assess candidate applications for pre-defined criteria as required by the Hiring Managers.
• Thoroughly explained Onboarding lifecycle process to candidates and answer questions as necessary.
• Maintained records of all hiring requisitions and followed through required approval process.
• Scheduling interview rounds and shortlisting applications along with communicating progressive updates to the required stakeholders.
• Recorded all data to a reporting system.

• Assist 3 doctors when he/she is interviewing and examining patients; take notes and document all procedures.
• Discuss the notes with the doctor before finalizing them in the report format.
• Retrieve audio files from the doctor's CRM and transcribe them to text format by using Dragon Speech Recognition.
• Clarify and verify the medical history, family and social history, and list of allergies and medications with patients.
• Prepare billing statements, organize patient records and notes by using EMR Bear.
• Complies with HIPAA confidentiality standards when accessing or communication patient information while scribing.
• Captures accurate and detailed description of patient encounters with a provider and enters into electronic medical record (EMR).
• Complies with specific standards that apply to the style of medical records and to the legal and ethical requirements for preparing medical documents and for keeping patient information confidential.

• May assist supervisor/manager in review of reports, staff development.
• Performs various duties including vocational evaluation, counseling, medical assessment, and coordinate return to work.
• May recommend and facilitate completion of peer reviews and independent medical examinations by obtaining and delivering medical records and diagnostic films notifying patients.
• Maintains contact and communicates with insurance adjusters to apprise them of case activity, case direction or receive authorization for services. Maintains contact with all parties involved on case, necessary for rehabilitation of the clients.
• May perform other related duties as assigned & meet with employers to review active files.
• Reviews cases with supervisor monthly to evaluate file and obtain direction.

• Monitored and recorded an average of 40 patients per day (e.g., obtained patients' vital signs by visual and auditory measures, triaged, and assessed their medical condition and prepared them for medical treatment by physicians and nurses).
• Electronically ordered lab, x-ray, and medical supplies as directed.
• Assisted nurses and physicians with various forms of patient treatment and care.
• Learned hands-on emergency medical techniques.
• Helped implement quality assurance and control programs that resulted in compliance with HIPAA and OSHA regulations.

• Review and adjudicate out-of-network payment disputes in accordance with IDRE and federal guidelines
• Analyze documentation submitted by providers and health plans
• Select and justify payment determinations between proposed offers
• Ensure accurate, timely documentation and data entry in government portals
• Collaborate with internal teams, partners, and clients to meet quality and productivity metrics
• Maintain confidentiality, compliance, and professionalism at all times
• Contribute to continuous quality improvement initiatives