Jasbir Singh
Citrus Heights,CA
Summary
Healthcare professional with 25 years of experience working in Medical and Insurance environments, seeking a full-time professional position that utilizes my skills and knowledge to further my career in healthcare. Determined collaborator with strong work ethics who is easily adaptable to various needs in any company, and enthusiastic about both patient care and great customer service. Effective communication skills and an effective listener who can work well under minimum supervision and is eager to learn more in other areas of the company.
Overview
30
30
years of professional experience
Work History
Provider Processor
Blue Shield of California
12.2003 - Current
- Analyze requests received from providers, medical group networks, contract managers and provider operations automation department to determine what type of maintenance is required.
- Verify credentialing, license, national provider IDs, service locations, billing locations, tax documents, provider names of corporation, Fictitious name statements or permits.
- Sent letters or contact credentialing managers or office of providers to request missing information required to complete requests.
- Build, update, and maintain individual provider demographic records using defined procedures and policies accurately.
- Build, update, and maintain provider group demographic records with multiple roster members.
- Process HMO and PPO lines of business to add, update or change network relationship between individual provider and networks.
- Process all lines of business to add, update or change network relationship between group, providers and networks.
- Expedite, research, and resolve records with flag indicators, missing images, and licensure issues tasks to appropriate internal partners.
- Build and maintain new provider network participation contract agreement.
- Process provider resignation and retirements requests.
- Participated in the pilot of symphony project, employee engagements and team building.
- Maintain EFT and ERA payment records.
Claims Adjudication and Claims Activity Support Team Advance Level Processor
Blue Shield of California
- Provide customer service to members, providers of all specialty types, provider liaison representatives, and other insurance carriers.
- Address inquiries received from different channels via incoming telephone calls, emails, and correspondence.
- Ensure appropriate response by performing routine research audits to verify the problem, resolve the problem, coordinate with other departments to expedite the issue to respond back with accurate information.
- Update the status of the inquiries in company records and respond by outgoing calls or via emails or written correspondence in a timely manner with the resolutions on the outcomes of the claims.
- Assist with multiple projects regarding documentation improvement in claims department with a goal of claim processing accuracy.
- Participate in training mode for recent changes to claims processing system and provide feedback.
- Make manual exception payment or adjudicate manual retro adjustments on claims for the providers and subscribers.
- Work on recoupment projects to review claim accuracy based on correct benefits, eligibility, pricing rate to make accurate payments on underpaid claims and save money on overpaid claims.
- Submitting stop pay requests on claims that paid incorrectly to wrong payee or address or an incorrect payment amount.
- Determine and apply correct interest to pay interest on claims.
- Monitoring high dollar and regular commercial escalated mailbox.
Coordination of Benefits Claims and General Claims Advance Level Processor
Blue Shield of California
- Processed commercial PPO, EPO, HMO, Medicare, Medical, Coordination of benefits claims, reviewed coding and payments going out with correct benefits, reprocessed claims to coordinate with submitted explanation of benefits from other insurance carriers.
- Resolved escalated cases for coordination of benefits department.
- Called other insurance carriers on daily basis for effective and cancel date of coverage.
- Updated coordination of benefits information in the system.
- Researched all claims in history to review and adjust those that were affected by the change of other carriers effective or cancel dates.
- Monitored Coordination of benefits escalated mailbox.
Installation and Membership Intermediate Level Processor
Blue Shield of California
- Processed and installed medical insurance applications for new members for Medicare Supplement plans and Individual product plans.
- Contacting applicants, brokers, agents, and product sales representatives on statuses of applications.
- Assisted Analysts with correction actions with research audits in a timely manner.
- Engaged in an inspector initiative-taking position who worked between processors and auditors to prevent enrollment processing errors for small group members.
- Customer service provided to patients, providers, inside sales agents, and brokers on phone or via email.
- Enrolled members and issued member identification numbers.
Front Medical Office receptionist
Associated Family Physicians Inc
10.1996 - 12.2003
- Medical billing and coding specialist
- Provider personal and phone call assistance to patients to resolve outstanding balances.
- Maintain and track medical transcription records.
- Record, monitor, file appeal to insurance companies, and track claims inventory.
- Submit outstanding accounts to collections agency.
Education
A.S. Degree - Administrative Medical Assistant
Heald Business College
10.1996
Skills
- Customer service experience, administrative experience, Medical Billing & Coding, Claims Adjudication, Medical Terminology, Anatomy and Physiology, bilingual in English and Hindi Typing 55 wpm
- Facets system, Provider Manager, Microsoft - Word, Excel, PowerPoint, Outlook, Teams, Business English, Business Math, Basic Algebra
Accomplishments
- Mental Health Document Improvement Mapping Project, 2019
- Contributed to identify root cause of claims paid in error, perform high level assessment analysis of behavioral Health claims, and assist payment integrity department with implementation of changes.
- Mental Health Recoupment Project, 2018
- Audited mental health claims for accuracy to assist Corporate Recovery department on recovering overpayments.
- Solera Wellness Program Project, 2017
- Main lead on analyzing the issue and reprocessing unpaid claims for preventative diabetes wellness program upon agreement contract.
Timeline
Provider Processor
Blue Shield of California
12.2003 - Current
Front Medical Office receptionist
Associated Family Physicians Inc
10.1996 - 12.2003
A.S. Degree - Administrative Medical Assistant
Heald Business College
Installation and Membership Intermediate Level Processor
Blue Shield of California
Coordination of Benefits Claims and General Claims Advance Level Processor
Blue Shield of California
Claims Adjudication and Claims Activity Support Team Advance Level Processor
Blue Shield of California