Neha Gouri
Claims service Representative
Vancouver,BC
Summary
Focused Physical Therapist committed to helping patients manage pain and injuries. Skillful in monitoring results and prescribing exercises for long-term health. Communicative and reliable professional well-versed in collaborating with practitioners and adhering to treatment instructions.
Claims Examiner with deep knowledge of healthcare claims industry. Solid abilities in developing objectives and strategies to settle healthcare insurance claims. Excellent skills compiling, coding, categorizing and auditing information to process claims.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Senior Clinical Investigator
Optum, UnitedHealth Group
11.2016 - 05.2023
- Identifying discrepancies between medical records and billed services for complex and high value claims
- Approving or denying the claims and identify provider aberrant behavior patterns.
- Preventing the payment of potentially fraudulent/ or abusive claims utilizing medical expertise, guidelines along with referring to client specific guidelines and member policies.
- Adherence to state and federal compliance policies and contract compliance.
- Assist the prospective team with special projects.
- Collaborated with physicians and other healthcare professionals to evaluate the effectiveness of treatments and diagnostic techniques.
- Trained and mentored new staff to achieve efficiency and maintain daily operational consistency.
Operations Associate
WNS Global Services
07.2015 - 11.2016
- Executed and maintained quality control processes to meet criteria and standards and increase customer satisfaction.
- Maintained and prioritized to-do-list and followed up to complete tasks on-time.
- Reviewing medical records and producing an accurate
summary of the patient’s medical history using medical knowledge to correct mistakes found in existing patient’s notes. - To work in accordance with the written protocol and policies
- Experience using Microsoft word and excel
Consultant Physiotherapist
MAX HEALTHCARE HOSPITAL, DELHI ,SAKET
01.2014 - 06.2015
- Conducted clinical assessment and evaluation to determine patient needs.
- Planned individually-designed treatment programs to restore, maintain and improve physical functioning, alleviate pain, and prevent disability.
- Adapted therapy sessions and exercises according to patient progress and limitations.
- Educated patients and family members regarding diagnosis, injury prevention, and therapeutic treatments.
- Managed acute and chronic conditions with full understanding regarding complex therapy needs.
- Recorded patient prognosis, treatment and responses into reports and patient charts.
- Evaluated physician referrals and determined appropriate evaluation procedures according to patient needs and medical history.
- Taught patients how to use braces, crutches, and prosthetic devices to reduce pain.
- Educated patients on proper body mechanics and injury prevention to avoid risk of re-injury.
Consultant Physiotherapist
FORTIS HOSPITAL, NOIDA
08.2012 - 09.2013
- Conducted clinical assessment and evaluation to determine patient needs.
- Recorded patient prognosis, treatment and responses into reports and patient charts.
- Stroke patient rehabilitation
- Pre and post-operative Physiotherapy after joint replacement
- Musculoskeletal and sports injuries & rehabilitation
- Ergonomics advisor for IT & BPO professionals
- Tapping techniques in sports injuries & in neurological condition
- Home care physiotherapy
- Neurology and neurosurgical rehabilitation
- Cardio thoracic & Critical intensive care units care.
- Pre and Post Operative rehabilitation for thoracic surgery patients with (Pectus excavatum) deformities.
- Managed high-volume caseload and organized daily schedules of assistants and patients.
- Taught patients how to use braces, crutches, and prosthetic devices to reduce pain.
- Provided physical therapy services in both inpatient and outpatient settings.
Education
BACHELOR OF PHYSIOTHERAPY - Physiotherapy
SBS UNIVERSITY
INDIA07.2011
Skills
- Declaration: I hereby declare that all the above information and facts are true to the best of my Knowledge and belief
- Claim Submission
- Fraud Patterns
- Electronic Medical Record
- Policy Making
- Data Management
- Claims Investigation and Research
- Query Escalation
- Physical Assessment
- Case Management
- Therapeutic Exercise
- Therapeutic Equipment
- Chronic Illness Management
Certification
- [Basic life Support-BLS] Training - [2 years]
Timeline
Senior Clinical Investigator
Optum, UnitedHealth Group
11.2016 - 05.2023
Operations Associate
WNS Global Services
07.2015 - 11.2016
Consultant Physiotherapist
MAX HEALTHCARE HOSPITAL, DELHI ,SAKET
01.2014 - 06.2015
Consultant Physiotherapist
FORTIS HOSPITAL, NOIDA
08.2012 - 09.2013
BACHELOR OF PHYSIOTHERAPY - Physiotherapy
SBS UNIVERSITY
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