shailender S.
Mid-Level Healthcare Claims Specialist
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Shailender S. is an experienced professional in the US healthcare sector with expertise at Optum Global Solutions Pvt Ltd. Focusing on claim adjudication, he was actively involved in the pilot batch of the COSMOS project. He effectively manages provider concerns related to both medical and hospital claims, and excels in processing payable and receivable claims, adhering to stringent client targets and quality standards. Adept at handling rework claims per process instructions, Shailender demonstrates strong capabilities in decision making and problem-solving, essential for timely revenue cycle management. At Nirvana Creative Telesoftware Pvt Ltd, he served as a senior charge poster, ensuring accurate billing and insurance claim submissions by verifying patient details and assigning correct CPT and ICD codes. Shailender's educational background includes a Bachelor of Arts from Rajasthan University, supporting his comprehensive understanding of the operational intricacies of US healthcare claims.
Experience
Claim adjudication
Optum global solution Pvt ltdParticipated in the Pilot Batch of the new project named COSMOS. Gained experience in US Healthcare focused on first pass and rework claims for the hospital department. Handled payable and receivable claims related to provider concerns, managing both medical and hospital claims as per established process instructions. Adjusted work practices to align with client targets, quality requirements, and turnaround time (TAT). Maintained daily logs for quality control tasks following company policy. Processed claims in accordance with company guidelines, provider agreements, and member liability. Resolved provider concerns promptly to facilitate quick payments and reduce aged claims. Engaged in team-building activities and supported colleagues with process clarifications. Conducted investigations regarding overpayments, underpayments, and funds requirements. Contributed to the quality team, performing quality analysis on payment processes. Reviewed medical records and policies to ascertain benefit eligibility.Senior charge poster
Nirvana creative Telesoftware pvt. ltd.Verified patient details and assigned correct CPT and ICD codes. Entered charges into the billing system and reviewed submissions for errors prior to claims submission to insurance.
Skills & Expertise
Education
- Bachelor of ArtsRajasthan university
- High schoolRajasthan board
- InterRajasthan board
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