Leena Sharma
Brampton,Ontario
Even if you are on the right track, you’ll get run over if you just sit there.
Will Rodgers
Summary
Dedicated medical billing professional with extensive experience in Revenue Cycle Management (RCM) within the US healthcare domain. Proficient in claims processing, and compliance with a strong track record of maximizing revenue for healthcare providers. Adept at resolving billing issues, optimizing reimbursement, and ensuring regulatory compliance. Proven ability to streamline processes and improve revenue flow, resulting in enhanced financial performance for healthcare organizations. Seeking to leverage my expertise to drive operational efficiency and financial success in the medical billing field.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Senior Claims Associate
Optum - UnitedHealth Group
02.2022 - 03.2023
- Claims Processing: Process and review complex insurance claims, ensuring accuracy and compliance with company policies and industry regulations.
- Claims Assessment:* Evaluate claim documentation, including policy coverage, medical records, and other relevant information to determine claim validity.
- Customer Interaction: Communicate with policyholders, claimants, and external parties to gather necessary information, explain claim processes, and provide updates on claim status.
- Quality Assurance: Review and provide feedback on claims processed by junior associates to ensure accuracy and compliance with company guidelines.
- Mentorship: Provide guidance and mentorship to junior claims associates, assisting in their professional development.
- Reporting:* Generate reports on claim trends, performance metrics, and key performance indicators (KPIs) for management review.
- Regulatory Compliance: Stay up-to-date with insurance regulations and compliance requirements to ensure claims processing aligns with industry standards.
Denial Specialist, Physician Billing
EMDS
03.2021 - 12.2021
- Check documentation for appropriate coding and making revision
- Handled billing related activities, focused on medical specialties
- Created agendas and communication materials for team meeting.
Senior Analyst
R1RCM
06.2018 - 02.2020
- Physician Billing | AR Follow-up
- Utilize vital data from all the resources and find out member eligibility with insurance companies to bill claims for maximum reimbursement
- Medical Claims Denial Management | Send appeals to payers.
Senior Practitioner, Customer Service Agent
Concentrix |
04.2017 - 03.2018
- Customer Interaction: Interact with customers via phone, email, chat, or in person to address inquiries, resolve issues, and provide information.
- Problem Solving: Identify and solve customer problems or complaints effectively and in a timely manner.
- Product/Service Knowledge: Maintain in-depth knowledge of the company's products or services to assist customers effectively.
- Communication: Communicate clearly and professionally to convey information, instructions, and solutions to customers.
- Documentation: Accurately record customer interactions, complaints, and resolutions in the company's database or CRM system.
- Adherence to Policies: Ensure compliance with company policies, procedures, and quality standards in all customer interactions.
- Performance Metrics: Meet or exceed key performance indicators (KPIs) such as response times, customer satisfaction scores, and call resolution rates.
- Customer Education: Educate customers on product features, benefits, and how to use them effectively.
Education
bachelor's degree -
that helps me to establish a fundamental understanding of international business and how various aspects of it apply to the real world. It's a well-rounded degree because it's so versatile. I need to succeed in the business world—like communication and leadership—with this degree, but I can also prepare Myself to work in dozens of other industries.
Bachelor of Business Administration (BBA) - undefined
Skills
- Tools & Software:
- IRIS Athena Epic
- US Physician Billing
- US Pharmacy Billing
- US RCM cycle
- US Denial Management
- AR Follow-up
- Medicare /Medicaid
- B2B /B2C knowledge
- Office 365 suits
- Microsoft Excel
- Good communication skills
- Quick learner
Certification
VSkills Certified: Claims Management.
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Senior Claims Associate - Optum - UnitedHealth Group
02.2022 - 03.2023
Denial Specialist, Physician Billing - EMDS
03.2021 - 12.2021
Senior Analyst - R1RCM
06.2018 - 02.2020
Senior Practitioner, Customer Service Agent - Concentrix |
04.2017 - 03.2018
- bachelor's degree,
Bharati Vidyapeeth Pune - Bachelor of Business Administration (BBA),
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