Dhara Patel

Monitored industry trends to adapt strategies accordingly.

Claim submission through AMD

Accounts receivables through AMD

Insurance company calls and email

• Create, update and maintain agent and agency licensing data
• Process State appointments and background checks
• Review agent contracts for accuracy
• Assist agents with questions via email.

• The Enrollment/Billing Lead Representative possesses specialized, advanced knowledge of the collections, editing and billing processes, serving as SME in handling escalated/complex claims
• Serves as back up to the Supervisor and provides training and mentoring of Enrollment/Billing Representatives
• Coordinates work and leads high level projects
• Provides report analysis & trend identification for reimbursement issues.

• Responsible for reworking claim denials, Initial Billing, and claim correction
• Verification of Insurance benefits
• A/R collection and Payer Analysis
• Perform full revenue cycle for medical insurance collections for multidisciplinary clinics
• Ability to stay on tasks and meet deadlines
• Responsible for patient referrals, prior authorization and patient follow-up
• Communication with clients and providers.

• Answering all patient inquiries via phone and in-office
• Obtain patient insurance data and transfer to EMR patient information
• Collect patient balances and establish payment plans as needed
• Maintain and ensure patient confidentiality as required by HIPAA
• Claim submission and claim denials.

• Verified Medicaid Process Online for IL, MI, and MD
• Probate Entry - Enter data for estate sales recovery for last illness
• Self-Pay Customers and worked with Medicaid Pending Applications process
• Handled all EFT/ERA enrollment process with all third party insurance
• Payer analysis worked with out of network, fee-schedule and actually amount of payment and created a spreadsheet to work out best third party insurance for out of network
• Handled Medicare Railroad applications process and EDI applications.