About Abdul Matin Shaikh

    • FunctionBilling, Coding, Credentialing
  • Specialty Healthcare Administration
  • Academic Level
  • Current Compensation: 480000
  • U.S Currency or Local Local Currency
  • Compensation Type Annually

Education

Experience

  • 2012 - 2015
    Location - Hyderabad India

    Quality Specialist-L2 at United Health Group Information Services Pvt. Ltd

    âž” Auditing of medical/healthcare claims for onshore and offshore business partners âž” Perform complex claims analysis and audit activities to identify trends, determine the root cause of payment inaccuracies, and recommend/implement process and systems improvements. âž” Resolve claims paid inaccurately. Determine when appropriate to write off the claim. âž” Document findings and recommendations and forward them to the appropriate internal division for resolution. âž” Includes use of multiple online and offline tools for quality audit purposes. âž” The core job is to identify missed payments, overpayments, underpayments, and denial management throughout the claims lifecycle within the process. âž” Facilitate the implementation of vendor programs supporting audit and recovery efforts. Compiles support documentation for audits. âž” Work through Provider Relations as well as directly with providers to recover overpayments and negotiate settlements when appropriate. âž” Regular sharing of feedback with team members to minimize inappropriate transactions. âž” Regular sharing of process-related updates via mails and SharePoint to improvise overall performance of production team. âž” Maintaining inventory flow, data backups, new updates, tips, and guidelines in proper database format for future references.

  • 2008 - 2012
    Location - Mumbai India

    Senior Associate at Wipro Bpo Solutions Ltd.

    âž” Processing and handling of health insurance claims transactions for client UHG âž” Handling adjudication, rework complex adjustments of Inpatient and Outpatient high-dollar claims. âž” Managing the smooth flow of inventory as per work queue requirements. âž” Providing process-related support to new joiners to achieve their metrics and goals. âž” Team contributor in achieving daily, weekly and monthly production and quality targets. âž” Awarded as the top performer for consecutive weeks and months for projects within the work queue.

  • 2016 - 2020
    Supervisor in Quality and Compliance Department

    Babaji Shivram Clearing and Carriers Pvt Ltd

    âž” Handling customer complaints and resolving issues that employees are not authorized to handle on their own. âž” Dealing with schedule changes, employee call-ins, and other staffing issues âž” Filling in for absent employees as needed to ensure smooth operation of the business âž” Acting as a role model for all employees by continuously exhibiting a high level of service and attention to detail in all tasks and delegating tasks to employees âž” Keeping day-to-day activities organized âž” Recruiting and interviewing new hires, Leading training classes, and providing one-on-one training to employees âž” Supervising employees and providing additional training and coaching as needed to ensure everyone is performing their job properly, resolving disputes between employees âž” Addressing employee problems on the job to ensure everyone is thriving in the workplace and satisfied with their job and work environment âž” Motivating employees to perform well and Maintaining a safe and clean work environment âž” Training employees in standard operating procedures and providing training updates as needed âž” Organizing promotions and spearheading marketing efforts by setting up displays and educating customers and employees on promotions or specials âž” Managing projects as assigned and organizing teams to assist in these efforts.

Expertise

MS-Excel, MS-Word, MS-Powerpoint, MS-Outlook
Unet Platform, Citrix - Comet Platform
Claims Management

Languages

English
Intermediate
Hindi
Intermediate
Marathi
Intermediate
Urdu
Intermediate

Honors & awards

Skills

Claims processing EOB and ERA Healthcare claims Adjudication Policy and Benefits Inpatient and outpatient claims Provider Billing denial management
 
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