Himanshu Dubey

Healthcare Analyst @Carelon Global Solutions India

Gurugram, IN

As an analyst my role is to Specializing in the timely and accurate processing of healthcare claims, ensuring seamless reimbursement experiences for providers and patients alike.My expertise includes:Authorization, Coordination of benifits, Corrected claims, Clinical trials, SNF, Acute inpatient, Ceris claims-Receive and review medical claims submissions from healthcare providers- Verify patient eligibility, coverage, and policy terms- Apply clinical guidelines and medical necessity criteriaDetermine claim approval, denial, or pend status- Conduct thorough investigations and research to resolve complex claims issues- Identify opportunities for process improvements and implement changes to enhance efficiency and accuracyCurrently working on Medicare -Professional, Inpatient, outpatient claims & Medicaid Claims.Using Tools- Facets, Maces, Pega application, ACMP, Provider Portal.

Institute of Technology and Management gorakhpur

Bachelor of Pharmacy - BPharm

Gorakhpur Public School

Intermediate