Srividya Manoj

• Receiving and verifying requested documentation from patients or their medical provider and analyzing correctness of HCPCS codes and Diagnosis codes
• Process rejections/non-qualified documentation by generating corrected documentation or requesting corrections made for any errors and verifying the same
• Handled high-volume escalation mailbox and went over 100 requests daily within pressured timeframes for productive medical operations.
• Follow up with physicians and patients regarding documentation requests and obtain appropriate documentation such as Wound care forms, letter of medical necessity, chart notes and acquired in-depth medical knowledge of Ostomy, DME, Diabetic, Wound Care, and Urology supplies.
• Working with verification, documentation and/or medical records and qualifying necessary documentation requests and approving shipments
• Importing and linking the necessary documentation in the system software

• Supervise Children and assist with homework or other activities
• Assist in planning and developing lesson plans that include arts, crafts, Music, games, sports, yoga, and science activities and experiments
• Support for remote learning and zoom classes according to their schedule and help with assignments
• Ability to support each child’s social and emotional development and encourage students to pursue their curiosity and interests.

Claims Related matters, scrutinizing and documents to be collected & forwarded, follow up. Receive all proposals, scrutinize them, arrange MERs, in-ward proposals and get policies and cards ready

Signing of policies and endorsements, out-ward and dispatch/handing over to IMDs concerned. Sorting queries and issues of IMDs, taking out collection report at end of day and ensuring that cash/checks are deposited on day-to-day basis

Carry out complete admin functions of the branch.

Handled heavy flow of daily paperwork and data entry, processing over 75 Prior authorization per day. To check whether claims is admissible as per policy terms and conditions and communicate to hospital accordingly

Contact insured/hospital or other involved persons to obtain missing information. Review insurance policy to determine coverage and documents for completeness

Transmit claims for payment or further investigation

Responsible for checking all claims (authorization, cashless claim, reimbursement claim and OPD claim) to ensure it is in line with insurance policy. Should warn of possible fraud claims to initiate investigations