Bhranti Patel
Little Elm,TX
Summary
I have extensive experience in medical billing, denials, appeals and phone interactions with insurance companies. I have a good knowledge of professional and hospital claims collection, including managed care, PPO, HMOs, Medicare, Medicaid and self-pay. Skilled in medical systems including Epic, Aprima, Provider Portals and Microsoft Office. I have a background in business management. Knowledge of HIPPA and FDCPA rules and regulations. I thrive in a challenging atmosphere and take pride in my performance and abilities.
Overview
9
9
years of professional experience
Work History
Account Adjuster - Revenue Cycle Credit Management
Ut Southwestern Medical Center
05.2022 - Current
- Conduct detailed reviews of medical claims to identify overpayments, billing errors, and discrepancies.
- Identify instances where insurance companies have made overpayments or errors in reimbursement.
- Process refunds to insurance companies accurately and promptly, ensuring compliance with organizational policies and regulatory standards.
- Investigate billing errors, coding discrepancies, and other issues affecting insurance claims.
- Seek appropriate approvals for adjustments to insurance claims, ensuring compliance with organizational policies.
- Verify eligibility through provider portals to identify correct primary and secondary insurance coverages.
- Communicate with insurance companies to resolve claim denials, overpayment issues, and other payment discrepancies.
- Provide necessary documentation and information to support the resolution of insurance-related issues.
- Stay informed about changes in insurance billing regulations and guidelines.
- Analyze trends and patterns in insurance claim recoupments and adjustments to identify areas for process improvement.
- Maintain accurate documentation of adjustments, refunds, and communications with insurance companies.
- Work closely with billing and revenue cycle teams to address issues related to claims.
- Provide feedback to leadership on issues affecting insurance claim accuracy and reimbursement.
Medical Collections Specialist
BayMark Health Services
12.2021 - 05.2022
- Conducted regular follow-ups on outstanding medical insurance claims to ensure timely reimbursement.
- Investigated and identified trends for claim denials, rejections, or delayed payments.
- Communicated with insurance companies to resolve claim denials and disputes.
- Submitted additional documentation or medical records as needed to support the resolution of denied claims.
- Identified and rectified discrepancies in payments, coding, or other claim-related information.
- Verified medical codes and modifiers submitted on claims align with the provided services.
- Addressed coding discrepancies to prevent claim denials due to coding errors.
- Corrected, completed and processed claims for payer codes.
- Prepared and submitted appeals for denied claims, providing necessary documentation to support the appeal.
- Monitored the progress of appeals and follow up accordingly.
Verified patient insurance information to ensure accurate billing. - Updated patient records with current insurance details and coverage information.
- Applied adjustments and contractual obligations as per the agreements with insurance providers.
- Monitored and managed accounts receivable aging reports, prioritizing and addressing aging claims.
- Developed and implemented strategies to reduce the number of aging claims.
- Maintained accurate documentation of all interactions with insurance providers, claim statuses, and collection efforts.
- Trained new team members on company policies, accounting systems and effective claims collection strategies.
Medical Billing and Collections Specialist
Diya Care Inc.
03.2020 - 10.2021
- Verified and updated patient demographic and insurance coverage to determine eligibility and confirmed benefits.
- Identified any pre-authorization requirements for specific procedures.
- Submitted medical insurance claims electronically with all necessary documentation and met insurance company requirements.
- Reconciled insurance payments with billed amounts to ensure accuracy.
- Conducted regular follow-ups on outstanding insurance claims to ensure timely reimbursement.
- Investigated and resolved claim denials, resubmitting claims when necessary.
- Analyzed reasons for claim denials and took corrective actions to prevent recurring issues.
- Submitted appeals and additional documentation to challenge and overturn denied claims.
- Identify and address discrepancies in payments, coding, or other claim-related information.
- Monitored and managed accounts receivable aging reports, prioritizing and addressing aging claims.
- Developed and implemented strategies to reduce the number of aging claims.
- Communicated effectively with insurance companies to inquire about claim statuses, payment delays, and other issues.
- Generated reports on billing and collections performance, providing regular updates to management.
- Maintained accurate documentation of all interactions with insurance companies, claim statuses, and collection efforts.
- Provided support and training to colleagues and other staff members on effective billing and collections strategies.
Office Administrative Assistant
Krishna Enterprise
03.2017 - 02.2019
- Responded to inquiries from callers seeking information.
- Maintained office supplies inventory by checking stock and ordering new supplies as needed.
- Developed and updated spreadsheets and databases to track, analyze and report on performance and sales data.
- Managed accounts payable and receivable.
- Recorded expenses and maintained accounting records.
- Updated employee files with new details such as changes in address or salary levels.
- Checked accrued hours against listed hours for leave time.
- Processed new hire paperwork and documents.
- Initiated direct deposits and prepared manual checks for 237 employees.
Academic Assistant
Jet Air Academy
01.2015 - 09.2016
- Answered student inquiries and resolved problems related to curriculum and course prerequisites.
- Coordinated follow up and student outreach to monitor academic progress for at-risk students.
- Maintained student database and electronic records for each student contact.
- Managed financial documentations such as expense reports and invoices.
- Increased school registrations over 15% with improved promotional approaches, outreach strategies and parent engagement plans.
- Handled 40 to 50 calls per day to address students inquiries and concerns.
- Monitored company inventory to keep stock levels and databases updated.
Education
Bachelor Of Design - Fashion And Fabric Consultation
Amor Design Institute
Vastrapur Lake, Ahmedabad, Gujarat, India 38005310.2014
Bachelor Of Business Administration - Accounting And Finance
Swami Sahajanand College of Commerce & Management
Iscon Mega City, Bhavnagar, Gujarat, India 36400111.2011
Skills
- Advanced proficiency in Medical Collections
- Insurance Claim Follow-Up and Resolution
- Insurance Credit Refunds and Adjustments
- Billing and Coding Knowledge
- Excellent Customer Service and Communication
- Account Reconciliation and Error Correction
- Insurance Verification Expertise
- Data Analysis and Reporting
- Critical Thinking
- Process Monitoring and Process Improvement
- Proficiency in Microsoft Office
- Critical Thinking
- Process Monitoring and Process Improvement
- Proficiency in Microsoft Office
Timeline
Account Adjuster - Revenue Cycle Credit Management
Ut Southwestern Medical Center
05.2022 - Current
Medical Collections Specialist
BayMark Health Services
12.2021 - 05.2022
Medical Billing and Collections Specialist
Diya Care Inc.
03.2020 - 10.2021
Office Administrative Assistant
Krishna Enterprise
03.2017 - 02.2019
Academic Assistant
Jet Air Academy
01.2015 - 09.2016
Bachelor Of Design - Fashion And Fabric Consultation
Amor Design Institute
Bachelor Of Business Administration - Accounting And Finance
Swami Sahajanand College of Commerce & Management
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