Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Sheetal Arora

Dayton,NJ

Summary

Detail-oriented Reimbursement Specialist with 8 years of experience in Revenue Cycle Management. Skilled in claims processing, denial management, insurance verification, and outpatient pediatric coding. Experienced in driving revenue growth through efficient billing and team collaboration. Expertise in analyzing KPIs for Accounts Receivable and claim denials using Power BI to provide actionable insights. Experienced in training team members to improve operations. Committed to using my skills to support the healthcare team, ensure prompt insurance reimbursement, and deliver exceptional patient care.

Overview

27
27
years of professional experience
1
1
Certification

Work History

Team Lead Reimbursement Specialist

Pediatrics Associates
05.2017 - Current
  • Review and Correct Billing, Coding, and Insurance Details During Claim Validation and Scrubbing.
  • Identify and resolve discrepancies in patient accounts, including billing errors, insurance information, CPT and ICD-10 codes, and modifiers.
  • Ensure alignment with payer requirements to reduce claim rejections, denials, and underpayments.
  • Monitor and Resolve Claim Denials: Review and track denied claims to identify root causes, such as coding errors, missing information, or policy issues.
  • Implement corrective actions and resubmit claims within payer-specific timeframes.
  • File appeals within billing cycle deadlines - Prepare and submit appeals for unresolved denials, ensuring compliance with payer guidelines and providing necessary documentation for claim reconsideration.
  • Maintain AR Below 15% for Claims Over 120 Days: Consistently monitor and follow up on unpaid claims to ensure that accounts receivable aged over 120 days remain below the 15% threshold.
  • Collaborate with Global Team: Work with the global team to resolve denied claims, follow up on unresponsive insurance claims, and address ERA posting issues, ensuring coordinated and timely resolution.
  • Staff Training: Educated staff on accurate patient information collection, insurance verification, and policy details to prevent billing errors and denials.
  • Patient services: Improve patient experience by explaining insurance plans, reviewing bills and EOBs, and offering financial counseling, including payment plans and assistance programs.
  • Patient Payments, Insurance Reimbursements, and Financial Reconciliation Management: Accurately post patient payments, track insurance reimbursements, and reconcile daily payments with billing records and deposit logs.
  • Physician Communication and Encounter Documentation Compliance: Coordinate with Physicians to Resolve Billing Issues and Ensure Timely Note Completion.
  • Escalate Recurring Issues for Swift Resolution: Identify billing, coding, or credentialing issues and escalate to leadership or payer contacts.
  • Strict Adherence to HIPAA Guidelines: Uphold the highest standards of patient confidentiality by strictly following the Health Insurance Portability and Accountability Act (HIPAA) regulations.

Consultant Dietitian

Weight Management Clinics, India
01.1998 - 01.2004
  • Conducted Comprehensive Nutritional Assessments: Evaluated individual patients' weight management goals and nutritional needs, considering underlying medical conditions to inform personalized dietary recommendations.
  • Developed Customized Meal Plans: Created tailored diet plans aligned with patients' weight loss or gain objectives, ensuring nutritional adequacy and cultural appropriateness.
  • Provided Nutritional Education: Educated patients on healthy lifestyle choices, emphasizing the importance of balanced diets and proper nutrition in achieving and maintaining optimal health.
  • Monitored Patient Progress: Regularly tracked patients' progress, making necessary adjustments to meal plans to ensure continued alignment with health goals and to address any emerging nutritional needs.
  • Engaged in Public Health Outreach: Participated in health and nutrition talk shows on local radio and television channels, disseminating information on weight management and healthy eating habits to a broader audience.

Education

Master of Science - Dietetics

M.S University
INDIA
08-1997

Skills

  • Healthcare Reimbursement & Revenue Cycle Management
  • Accounts Receivable (AR) Oversight
  • Electronic Health Records (EHR) Systems
  • Data Analysis & Reporting Tools
  • Medical Coding Expertise
  • Claim Forms Proficiency
  • Regulatory Compliance
  • Microsoft Office Suite
  • Cross-Functional Collaboration
  • Time Management
  • Effective Verbal and Written Communication Skills
  • Problem Solving
  • Analytical Thinking
  • Attention to Detail
  • Teamwork
  • Customer Service Excellence

Certification

  • Certified Professional Coder (CPC), 03/01/17, American Academy of Professional Coders (AAPC)
  • Certified in Artificial Intelligence applications in Medical Coding and Billing, 03/01/25, American Academy of Professional Coders (AAPC)

Timeline

Team Lead Reimbursement Specialist

Pediatrics Associates
05.2017 - Current

Consultant Dietitian

Weight Management Clinics, India
01.1998 - 01.2004

Master of Science - Dietetics

M.S University

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