Ashika Prasad
Sacramento,CA
Summary
Driven Healthcare professional with 15 years of hands on experience in a fast-paced healthcare industry. Very motivated and compassionate about my work and job duties. Seeking a position that offers professional challenges utilizing current skills, with a chance for advancement and the opportunity to expand any knowledge and experience.
Overview
15
15
years of professional experience
Work History
CA Coding Analyst
Centene Corporation (Healthnet)
Rancho Cordova, CA
02.2018 - 08.2021
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations and utilizing broad based product/system knowledge to ensure timely payments are generated.
- Reviewed high dollar CA Medicare/Marketplace claims.
- Responsible for entire cycle of high dollar claims processing which included verifying information on submitted claims based on compliance guidelines and state regulation.
- Verification of eligibility and authorizations to determine reimbursement and releasing claim for payment.
- Identifying key elements and processing requirements based on diagnosis , provider contracts, policies and procedure .
- Conducting point of service review of high dollar claims that are pending and/or processed incorrectly. Including review, investigation, appeals and adjustment of such claims as required for resolution.
- Reviewed and processed high dollar transplant claims per contract.
- Reviewed and processed Hemodialysis and chemotherapy claims.
- Reviewed and processed COB claims.
- Calculated and applied interest to high dollar claims per daily report.
- Collaborated with all departments to analyze and resolve complex claim issues.
- Special claims projects and reports as assigned by upper management and department need. Researched issues related to claims processing to identify origins and implement corrective solutions.
Claims Auditor
HealthNet Of California ( Centene Corp)
Rancho Cordova, CA - California
05.2010 - 02.2018
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Audited processed and adjustment claims in all lines of business. Dual, HMO, PPO, POS, homehealth, Medicare advantage, Flexnet and high dollar medical for all regions California, Oregon and Arizona.
- Prioritized daily tasks to satisfy workload demands and department's turnaround goals.
- Initiated cost containment by conducting thorough audits.
- Researched issues related to claims processing to identify origins and implement corrective solutions.
- Worked on projects per department need.
Claims Examiner
Health Net
Rancho Cordova, CA
08.2006 - 05.2010
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Paid or denied medical claims based upon established claims processing criteria for lines of business PPO, POS, HMO and Medicare.
- Processed large volume of medical claims on daily basis.
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
- Worked on special projects per department need.
Education
Diploma - Medical Billing And Coding
High Tech Institute
Rancho Cordova, CA2006
Skills
Medical Billing and coding skills
Professional coding practices - CPT 4, ICD-9, ICD-10, HCPCS
- Attention to detail and thorough note taking
- HIPAA Regulations
- Health Insurance Industry Knowledge - claims processing
- Fast learner
- Team oriented
- Internet savvy and proficient with Microsoft Word, Outlook, Excel
Additional Software Programs: Lotus Notes, ABS, Amisys Advance, Cenpas, Truecare, Filenet, Omni Prod, Webstrat, CSI, Macess, Burgess pricer, AWP drug pricer and Psas
Languages
English
Hindi
Timeline
CA Coding Analyst
Centene Corporation (Healthnet)
02.2018 - 08.2021
Claims Auditor
HealthNet Of California ( Centene Corp)
05.2010 - 02.2018
Claims Examiner
Health Net
08.2006 - 05.2010
Diploma - Medical Billing And Coding
High Tech Institute
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