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

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

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

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