Israr Ahmed
Billing Lead at Care One Pharmacy Services LLC- Claim this Profile
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English -
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Urdu -
Topline Score
Bio
Credentials
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Pharmacy Technician
Illinois Department of Financial and Professional RegulationDec, 2006- Nov, 2024
Experience
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Care One Pharmacy Services LLC
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United States
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Pharmaceutical Manufacturing
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1 - 100 Employee
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Billing Lead
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Oct 2019 - Present
Consult SNF Management regarding drug cost containment, drug pre-authorization requests for carved-out payments, and develop therapeutic interchange formularies. Improved reimbursements by $10,000+ monthly by navigating and implementing proper claim submissions to primary and secondary payors. Overall, I increased pharmacy revenue by 40% per fiscal year for the past 3 years. Responsibilities: • Audit Compliance & Risk Management • Obtaining and negotiating third-party contracts. • Consulting and explaining insurance processes and regulatory matters. • Revenue Cycle Reporting • Data Analysis – Financial & Healthcare • Collections • Immunization Clinic workflow optimization Knowledgeable Areas: • Medical & Pharmacy Claims • Insurance Reimbursement • Medicare & Medicaid Laws & Regulations • Skilled Nursing & Rehabilitation Billing • Medical Billing • PBM Payment, Pricing, & Drug Costs • PBM Contracting • Pharmacy Practice Laws & Regulations • Inventory Control Skills: FrameworkLTC, Softwriters, Microsoft BI, Power Automate, Python, Microsoft Office including Excel, Power Pivot & Tables, Crystal Reports, Moderate SQL, Data Manipulation, Net-rx and MHA, NCPDP Formatting, Adobe Acrobat Pro
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UVANTA Healthcare
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United States
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Hospitals and Health Care
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1 - 100 Employee
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Billing Specialist
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Feb 2019 - Oct 2019
Uvanta Pharmacy renders prescription services to long term care facilities, including Hospice, Skilled Nursing, Assisted Living, & Group Homes. At Uvanta, I improved processes for MAC appeals, credit card payments, and organization of data by utilizing software systems. • Find insurance coverage for new patients & bill claims appropriately. • Create billing statements for facilities. • Process payments • MAC & Reimbursement Appeals • Review paid claims & insure they are paid according to contracted rates. • Investigate rejected claims & resolve issues with insurance companies.
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Guarantee Trust Life Insurance Company
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United States
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Insurance
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100 - 200 Employee
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Medical Claims Adjuster
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Jul 2018 - Oct 2018
Responsible for authorizing payments or denials for hospital indemnity claims by examining the necessary information presented in documents such as UB-04’s, Itemized bills, pathology reports, and medical records. In addition, I independently worked on side projects to improve the accuracy and reduce the time of processing claims. By identifying an unknown software function that allowed exporting claim data to excel, I was able to take the claim inventory and create an organized database that allowed us to manipulate the data and distribute work accordingly. The project resulted in a higher accuracy rate while simultaneously reducing claim inventory volumes and claim interest payments. In addition, by utilizing my pharmacy experience, I helped the prescription claims team identify and close gaps they were facing in processing claims. • Professionally drafted correspondences to the policyholders to explain benefits as defined in their policy. • Interpret icd-10 and procedure coding • Comply with federal and state laws, plan policy and company procedures. • Investigated contestable policies by examining medical records against the application questions to identify fraud, waste, and abuse. When necessary, rescinded fraudulent policies based on the findings. • Adjusted benefits for cancer, long and short duration hospital visits, surgery, injury, medical supply, ambulance, and nursing home claims.
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Conduent
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United States
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IT Services and IT Consulting
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700 & Above Employee
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Clinical Specialist
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Nov 2014 - Jul 2018
Investigated applicants for Health and Life insurance policies to determined risk classification based on examining and organizing multiple data factors including, but not limited to, paramedic exams, height and weight, blood test results, urine test results, Attending Physician Statements, occupational, travel risks, financial, motor vehicle, and health risks. • Communicated the rationale for underwriting decisions and risk-level analysis to sales representatives. • Conversational phone skills with applicants, agents, and healthcare providers • Understanding of risk and legal aspects of insurance contracts and underwriting guidelines • Medical terminology including medical science
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Walgreens
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United States
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Retail
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700 & Above Employee
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Lead Pharmacy Technician
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Jan 2008 - Dec 2014
Prioritize tasks to meet the goal of filling over 300 prescriptions daily. Managed a team of three or more technicians; assigned tasks to ensure workflow and meet daily goals. • Utilize organization skills to collect patient information and manage medication distribution. • Resolved insurance issues and helped customers understand their policies. • Managed inventory by placing orders to ensure we have medications available for our customers at all times. • Demonstrate ethical conduct and maintain patient confidentiality; strong understanding of HIPAA protocols. • Apply effective communication skills to provide drug information and education to the customer under the direction and supervision of a licensed pharmacist. • Trained new technicians on proper handling of required tasks. • Attended local events promoting Walgreens medicare enrollment, immunization, and outreach programs.
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CVS Pharmacy
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United States
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Pharmaceutical Manufacturing
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700 & Above Employee
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Pharmacy Technician
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Mar 2014 - Nov 2014
Adjust insurance reimbursement claims for specialty medication. Understanding and manipulating data on a Unix platform Skills necessary to complete tasks are as following: • Prescription insurance billing and reimbursement • Understanding of pharmaceutical therapeutics for chronic conditions Adjust insurance reimbursement claims for specialty medication. Understanding and manipulating data on a Unix platform Skills necessary to complete tasks are as following: • Prescription insurance billing and reimbursement • Understanding of pharmaceutical therapeutics for chronic conditions
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Accusoft Tax & Consulting
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Skokie, Illinois
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CPA Office Manager
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Jun 2012 - Jul 2013
Prepare tax returns for individuals and businesses. Manage our clients’ business payrolls, employee information, and provide internal audits. Skills necessary to complete tasks are as following: • Manipulating and organizing spreadsheets in Excel • Utilizing Quickbooks Prepare tax returns for individuals and businesses. Manage our clients’ business payrolls, employee information, and provide internal audits. Skills necessary to complete tasks are as following: • Manipulating and organizing spreadsheets in Excel • Utilizing Quickbooks
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Education
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Triton-College
Bachelor's Science/Accounting & Business Administration, Health/Health Care Administration/Management -
2005 - 2009
Niles West High School
Community
