Mohammed Naveed Khan

About Mohammed Naveed Khan

Extensive experience in US health insurance domain with a 8 plus years in claim processing experience.Knowledge of health insurance Medicare, Medicaid and Commercial plans (HMO, PPO, EPO and POS)Extensive knowledge and understanding of member accumulators – Individual and family cost share, Copay’s, Co-insurance, deductibles and Out of pocket maximums.Proficient level adjudicator providing strong analytical skills to review claim rules and workflows.Responsible for adjudicating claims to maintain and reconcile the member\'s accumulators andEnsuring timeliness and accuracy in reprocessing claims and reconciling of member accumulators.Ability to understand the logic of standard medical coding (i.e.CPT, ICD-10, HCPCS and Rev Codes, Modifiers etc.)Currently associated with Cotiviti since Nov-2021

Experience

1. Senior Associate Auditor

   Cotiviti

   Nov 2021 — Present · Hyderabad, IN

   Auditing the patient’s medical records as per the HIPPA guidelines for different healthcare providers.• Responsible for examining indexing and auditing the medical records.• Medical Record Bookmarking - Develops subject matter expertise in the terminology and formatting of medical records used in various provider settings.• Creates provider-specific templates to bookmark records, by searching records from relevant chart elements.• Collaborates with auditors and IT team to resolve clinical and technical issues related to bookmarking.• May examine and index some medical records, to determine sufficiency for review.• Meets or Exceeds Standards for Quality and Productivity - Maintains productivity and Quality goals and standards set by the department.• Obtains data files and/or generates reports relevant to bookmarking activity and opportunities to enhance productivity.• • Review the overdue Invoices analyze payments and invoicing trends, tracking and resolving problems related to payments. • As requested, or required, communicates directly with healthcare providers following established process and procedures.

Education

• Kakatiya University

  BCom-, Bachelor of Commerce, Accounting and Finance

  2013 — 2016

• Osmania University

  MBA/PG Diploma in Business Mgmt, Finance, General

• Osmania University

  Master of Business Administration - MBA, Finance

  2016 — 2019

• Kakatiya University

  Bachelor of Commerce, Business/Commerce, General