Enrollment Specialist with 10 years of
experience in customer service,
enrollment processes, and data entry.
Experienced in system navigation,
database maintenance, and report
generation.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Health Care & Insurance Operations Senior Market
NTT Data
08.2023 - Current
Resolved complex claims issues promptly, demonstrating excellent problem-solving skills and attention to detail.
Maintained strict adherence to regulatory guidelines, ensuring compliance and mitigating risks.
Implemented effective communication strategies within the team, promoting collaboration and information sharing across departments.
Conducted thorough research on insurance policies to provide accurate information and guidance to clients.
Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Assisted with employee training initiatives, sharing knowledge on processes and systems for a more efficient workforce.
Systems used to process are Facets ,DPBMS, sales force
Modified, updated and processed existing policies.
Knowledge of medicaid & medicare
Managing Director operations
Rocket city Learning Center
01.2021 - Current
Responsible for planning, organizing, and coordinating the daily professional operations and training & supervising staff
Manage Billing & invoicing
Attend network events and advertise the benefits of getting tutored at the learning center
Collect and analyze call-center statistics (sales and customer service metrics etc
Enjoy working in a busy & varied environment
Take up teaching as & when required.
Medical Billing and Office Administration
Happi Urgent Care Huntsville AL
06.2018 - 10.2020
Verified insurance coverage and assisted the billing department with processing claims
Answered multi-line phone system and directed calls to the appropriate party
Greeted patients upon arrival and provided necessary paperwork or other information
Scheduled and confirmed appointments
Evaluated payments/denials received for correctness
Checked eligibility and benefit verification
Obtained referrals and pre-authorizations as required for procedures
Adhered to regulatory/payor guidelines and policies & procedures
Reviewed patient bills for accuracy and completeness and obtain any missing information
Prepared, reviewed, and transmitted claims using billing software, including electronic and paper claim processing
Knowledge of insurance guidelines, including HMO/PPO, Medicare, and state Medicaid
Follow up on unpaid claims within standard billing cycle timeframe
Called insurance companies regarding any discrepancy in payments if necessary
Reviewed accounts for insurance or patient follow up
Researched and appealed denied claims
Updated cash spreadsheet, runs collection reports
Handled patient or insurance telephone inquiries pertaining to assigned accounts
Applied ICD-10 coding under supervisor
Used tools to convert ICD-9 codes.
Department Manager
Walmart - Madison, AL
08.2015 - 01.2020
Recruiting, interviewing, and orienting new staff members
Setting strategic long and short-term departmental goals and evaluating outcomes
Motivating and inspiring staff and facilitating personal growth
Ensuring high levels of productivity are maintained
Ensuring the highest levels of quality are met
Communicating job expectations to staff
Conducting training and seminars for continued skills improvement
Fostering a productive working environment.
Education
Bachelors in Commerce -
Osmania University
06.1993
Skills
Claims Investigation
HIPAA Compliance
Healthcare regulations
Workflow Optimization
Insurance compliance
Customer Service
Organizing and Prioritizing Work
Claims Processing
Documentation skills
Excellent administrative abilities
Medicaid knowledge
Eligibility Determination
Data Entry Software
Certification
Diploma in Computer Science
Diploma in Medical Insurance and Office Administration from Ross Medical School Huntsville Al (2017-2018)
Director - Cloud & Infrastructure Services at NTT DATA Services (Previously NTT/Netmagic)Director - Cloud & Infrastructure Services at NTT DATA Services (Previously NTT/Netmagic)
Service Desk Analyst / Acting Shift Lead at NTT GDC India Private Limited / NTT DataService Desk Analyst / Acting Shift Lead at NTT GDC India Private Limited / NTT Data