Saleem Khan
Tampa
Summary
Experienced claims processing and examination professional specializing in outpatient pharmacy facilities and professional services. Analyzes, reviews, and adjudicates claims across various categories including pharmacy, medical, hospital, institutional, and professional services. Strong understanding of claims processing and adjustment with knowledge of medical terminology and coding. Proficient in Diamond Software, CMS/HCFA 1500 Version 08-05 and Version 02/12 for professional billing, as well as UB-04 for pharmacy services, hospitals, and institutional care. Recognized for exceptional end-to-end service to internal and external stakeholders. Proficient in Diamond Software, Facets, AS400, and Content Manager.
Overview
21
21
years of professional experience
Work History
Real Estate Broker
Divine Estates Realty
06.2021 - Current
- Developed and implemented marketing strategies to promote the sale of residential properties.
- Analyzed market trends and conducted research to identify potential buyers for properties.
- Provided guidance regarding local zoning laws, homeowner association rules, mortgage requirements, escrow procedures, title insurance policies.
- Drafted real estate contracts, purchase agreements, and closing documents according to state regulations.
- Assisted clients with obtaining financing options that best suited their needs as well as ensuring loan applications were properly completed and submitted.
- Monitored progress of transactions from start-to-finish including staying abreast of any changes or issues that arose during the process.
- Attended continuing education classes regularly in order maintain up-to-date knowledge about real estate law and industry practices.
Billing Specialist/Audit and Compliance Manager
RXPERTS Pharmacy
11.2010 - 07.2021
- Ensured consistent workflow, processing HCFA 20/HR and UB92 15/HR medical claims on a daily basis.
- Ensured error rate stayed under 1% on a daily basis
- Maintained compliance with laws and regulations through meticulous citation analysis of all documents
- Verified compliance of justification submissions with industry-standard coding systems like CPT, HCPCS and ICD-9-CM
- Demonstrated proficiency in utilizing various electronic features for claim editing and submission, including on-line claim processing and query systems.
- Displayed extensive knowledge of medical billing forms, ensuring accurate processing of claims for optimal reimbursement.
- Implemented precise diagnostic and procedural coding on different types of claim forms including HCFA-1500 and UB92
- Conducted thorough review of medical records to verify the precision of billing information and patient data.
- Reviewed, researched and investigated claims to provide expertise in support of general claims processes.
- Cross-trained employees, enabling completion of priority tasks during personnel absences.
- Efficiently managed and completed both internal and external audits, including leading teams for complex projects.
- Reduced audit fees by bringing audit processes in-house.
- Assessed compliance risk, developed audit work plans and documented findings.
- Researched complex billing errors that required an in-depth review of all available documentation before resolution could be reached.
- Collaborated with pharmacists and physicians to ensure coverage of high-ticket medical items, such as cancer medications, TPNs, and oral therapies.
- Maintained efficient management of returned medications and credited them appropriately.
- Ensured processes upheld PHI secrecy.
- Investigated and resolved billing issues to maximize cash flow and minimize liabilities.
- Utilized systems such as Framework, DocuTrack, AS400 for daily operations.
Claims Specialist/Examiner/Auditor
Claims Division Integrity Medical (Remote)
08.2006 - 10.2010
- Identified discrepancies in billing information to ensure accuracy of financial records
- Achieved efficient claim processing by utilizing the Diamond platform
- Efficiently organized and executed setup of State Medicaid & Medicare benefits for the Company in the Diamond system.
- Successfully managed the analysis and billing of approximately 450 medical claims daily for 8 distinct nursing facilities.
- Demonstrated extensive knowledge of claim processing from start to finish by effectively utilizing ICD-9 and CPT codes
- Managed and processed claims using Xcelys system
- Managed the processing of professional and institutional claims.
- Kept up-to-date with CPT and ICD-9 coding principles, government regulations, protocols as well as third-party requirements pertaining to billing.
- Conducted meticulous analysis of remittance codes from Explanation of Benefits (EOB) and Account Receivable (AR)
- Guaranteed proper submission of claims in a timely manner, whether through electronic means or hard copies
- Utilized extensive expertise in HIPAA Privacy and Security Regulations to ensure proper handling of patient information.
- Utilized DIAMOND, Xcelys, and Javelina systems to enhance overall efficiency.
Claims Specialist
USA Services Group
11.2003 - 08.2006
- Evaluated policy or certificate provisions to determine covered medical insurance losses.
- Ensured timely communication of software problems for prompt resolution.
- Proficiently recorded medical claims actions by completing necessary documents such as forms, reports, logs, and records.
- Resolved medical claims through the approval or denial of documentation, calculation of benefit due, initiation of payment, and composition of denial letters.
- Maintained legal compliance through consistent adherence to company policies, procedures, guidelines, and state/federal insurance regulations.
- Implemented effective strategies to deliver excellent customer service through adherence to established protocols and responsiveness to all customer inquiries.
- Managed daily adjudication of approximately 300 Encounter claims.
- Maintained productivity by accurately processing fees for service claims and meeting daily targets of 130 professional and 65 hospital claims, while consistently achieving an error rate below 3%.
- Maintained confidentiality of claims information to ensure protection of operations.
- Generated comprehensive reports by gathering and interpreting data
- Diligently examined potential duplicate claim submissions and conducted in-depth research on cases involving Third Party Liability (TPL) and financial responsibility claims of another payer that had been erroneously paid or reimbursed inaccurately
- Used benefit codes to accurately interpret benefits and adjudicate UB92 and HCFA claims, resulting in correct payment of claims.
- Systems used: Diamond
Education
High School Diploma -
Gateway High School
Kissimmee, FL06.2002
Skills
- Microsoft Office,Windows
- Health Care Claims Processing System
- Facets
- Diamond
- Rims
- AS400
- DocuTrack
- Amisys Q-CareWE
- HRP
- HSP
- Macess
- Xcelys
Timeline
Real Estate Broker
Divine Estates Realty
06.2021 - Current
Billing Specialist/Audit and Compliance Manager
RXPERTS Pharmacy
11.2010 - 07.2021
Claims Specialist/Examiner/Auditor
Claims Division Integrity Medical (Remote)
08.2006 - 10.2010
Claims Specialist
USA Services Group
11.2003 - 08.2006
High School Diploma -
Gateway High School
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