Shivani Nahar

About Shivani Nahar

I have experience in validating benefits such as co-payments and deductibles, maintaining accurate records of prior authorization requests, and verifying patient insurance coverage, benefits, and cost- sharing responsibilities. I am skilled at communicating with stakeholders, collecting and organizing medical information, and advocating for patients when care is denied. I can obtain authorization, verify benefits and eligibility, and process incoming requests. My problem-solving abilities are strong, and I can easily utilize CPT and ICD-10 codes. Additionally, I have a solid understanding of payer medical policy guidelines and can generate reports effectively.

Experience

1. Process Associate

   Fedora Solutions

   Jul 2022 — Present · Pune, IN

   To Initiate and aggressively follow up on pre-authorizations with payers wherever required to ensure that clients can deliver their services to patients without fear of non-payment• Undertaking data entry tasks, approving, or denying claims processing, overseeing insurance claims reimbursements, checking insurance information, and handling the verification of insurance benefits for customers• Taking follow-up on Patient Scans/Authorization by providing Clinical on the web portal or by Online call• Maintain and track authorization for 650 clients from all payer sources• Responsible for providing accurate and complete data input for precertification requests and for providing excellent customer service• Scheduling calls with the insurance department and obtaining authorization for patients on behalf of the provider’s office• Responsible for verifying and obtaining authorizations as insurance companies require for new and existing patients via phone or online• Get insurance authorizations for home health care from different payors and work with all major medical plans, including Medicare, Medicaid, and Tricare• Completed accurate and timely authorization requests, including ensuring all necessary data elements needed for authorization (CPT Code, Dx code, NDC code, Revenue code, Procedure name, Patient name, DOB, Facility name, Provide name, National Provider Identifier of Facility and Provider)• Skilled in interacting with insurance companies, third-party payers, and other relevant stakeholders to advocate for timely approval of prior authorization requests.• Audited claims worked by junior team members• Trained new joined employees

Education

• Savitribai Phule Pune University

  Bachelor of Pharmacy - B. Pharmacy

  2018 — 2022