Farooq Mohammed
Senior Service Coordinator @The Stepping Stones Group, LLC
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WORK HISTORY
Senior Service Coordinator @The Stepping Stones Group, LLC
Hyderabad, IN
Assist in the development and implement Medical Claims Review processes and procedures • Create work flows. Proficient using ICD9/CPT/HCPC codes, review clinical to apply scripted guidelines, ensure plan benefits are applied correctly; perform telephonic and on-line authorization of routine services and procedures. • Contact specialty care providers, as well as, on-line data entry of authorizations/denials and other various related functions. Assist in educating and act as a resource to primary and specialty care providers concerning certification and notification as required by various clients. • Assist in the identification and reporting of potential quality management issues as well as case management issues. • Gather information needed for coordinators and case managers to determine continued authorization. • Assist in the development and/or creation of adhoc reporting as requested by clients to identify high dollar services, statistics, demographic profiles,
EDUCATION
Alagappa University, Alagappa Nagar, Karaikudi
Master of Business Administration (M.B.A.), Finance and Financial Management Services, A
Hari Krishna High school
Board of Secondary Certificate
ABOUT FAROOQ MOHAMMED
Responsible in submission of claims Inpatient/Outpatient includes Long Term Case,Transfer Case. Adjudicates for provision of deductibles, co-pays, co-insurance maximums and provider settlements. Monitor the receipt allocation manually through.xml in the system as per payment details provided by the insurance companies. Provided timely customer service to members, providers, billing departments and other insurance companies on the subject of claims. Responsible for Settlement of Credit/Cash and Credit invoices, prepares insurance claims for submission to insurance companies or TPAs. Actively participated with department Head on all Insurance companies empanelment process and have been a part of tariff negotiation and network related queries/concerns • Handle a high volume of 80 incoming calls and 30 incoming emails within a deadline driven environment. • Experienced with Microsoft word, excel, power point, outlook. Accurately input data entry of medical & hospital claims information into processing system. • Knowledge of Medical terminology, ICD9, CPT, HCPS codes, paid or rejected health insurance claims. • Navigated through various databases and programs for updating and maintenance daily. • Daily follow-up on claims and correspondence. • File and process client insurance claims • Ensure the coverage and figure the payment amount for each claim • Draft and send statements of amount of coverage and amount owed to the customer • Send payments to doctors offices or hospitals for covered procedures • Assist new customers in signing up for insurance coverage • Enter all customer information into the computer system for future record • Reimburse customers for payments made that should have been covered • Help with customer appeals to denied claims • Associated with all companies which are in to health insurance process like. Proactive and competent HR professional with strong track –record of delivering top performance. Interested in career path packed with HR/ Admin duties and responsibilities, currently working with RENEE GEOUP OF HOSPITALS (Telangana). Workes on HIMS & HRIS Software knowledge of TOAD Solutions oriented approach with excellent relationship management skills, successfully and consistently delivering the responsibilities thereby streamlining HR. Excellent time management skills with proven ability to work accurately, prioritize quickly, coordinate and consolidate tasks while simultaneously managing the diverse range of functions from multiple sources.
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