Experience

CareEco

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Claim Adjudication Engineer

  • Jul 2023 - Present

  CareEco creates user-friendly technology designed to improve the health of patients and the efficiency of healthcare operations. We believe that technology can enable better access and more affordability of healthcare for all people. We are passionate about improving the healthcare experience and desired to build a better ecosystem of care for both the patient and the provider. CareEco creates user-friendly technology designed to improve the health of patients and the efficiency of healthcare operations. We believe that technology can enable better access and more affordability of healthcare for all people. We are passionate about improving the healthcare experience and desired to build a better ecosystem of care for both the patient and the provider.



Cognizant

• United States
• IT Services and IT Consulting
• 700 & Above Employee

• Claims Auditor

  • Jan 2023 - Jul 2023

  - Conducted thorough audits of insurance claims to ensure compliance with policies, procedures, and regulatory requirements.- Reviewed claim documentation, including medical records and coding, to identify errors, inconsistencies, and potential fraud.- Analyzed claims data and identified trends, patterns, and anomalies to proactively detect and prevent inaccuracies or fraudulent activities.- Collaborated with internal teams, including claims processors, to address audit findings, implement corrective actions, and improve claims processes.- Prepared detailed audit reports outlining findings, recommendations, and areas for improvement.- Assisted in the development and enhancement of audit procedures and protocols, ensuring continuous improvement and adherence to best practices.- Stayed updated with industry trends, regulatory changes, and emerging issues in claims auditing to maintain expertise and effectiveness. Show less

• Process Executive

  • Nov 2021 - Dec 2022

  - Reviewing and assessing insurance claims forms Professional (HCFA-1500), Institutional (UB-04)submitted by providers. Examine the claim forms, supporting documentation, and policy details to determine the coverage and eligibility of the claim.- Resolved medical claims authorization, COB, duplicate, pricing and corrected claims by approving or denying documentations, calculating benefits due, imitated payments or composing denial letter.- Conducted investigations to gather additional information related to the claim by effectively communicating with the healthcare providers to obtain relevant details, such as medical records, EOB or invoices.- Thorough reviews of insurance claims, ensuring compliance with policy guidelines, medical coding standards, and reimbursement protocols. Strong knowledge about in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum benefits.- Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims.- Maintained a high level of 100% accuracy in all responses while ensuring compliance with the company's policies and procedures.- Assisted in the development and implementation of process improvements by internal auditing the claims to enhance 100% efficiency and accuracy. Show less