Afreen Fathima

AFREEN FATHIMA BIJLI Z CREDENTIALING SUPERVISOR CONTACT --TVS Nagar, Madurai. EDUCATION PROFILE A hard working lead that performs and delegates all multiple duties in respectful and professional manner. A Healthcare Domain professional with expertise in credentialing and supervision, responsible for verifying and maintaining provider credentials and certifications, ensuring compliance with Regulatory requirements. With strong analytical and problem solving skills, attention to detail and ability to meet deadlines. WORK EXPERIENCE 2008 - 2011 HCH TECHNOLOGY PVT LTD JUSTICE BASHEER AHAMED Credentialing Supervisor JUNE 2022 - PRESENT COLLEGE, CHENNAI. Bachelor of Commerce 2011 - 2013 UNIVERSITY OF MADRAS, CHENNAI MBA - Hospitality Management SOFTWARES CAQH Backstage ECS AMDI Blue Ocean Symplr Advanced Medical Billing Epic Optum Maintain accurate records of provider credentials and verification activities in accordance with policies and regulations. Obtain and Update Providers information accurately into the Sofware. Coordinate the successful integration of new providers into the system. Execute verification of educational qualifications, licenses, insurance, and disclosure items based on CAQH checklist and ProView documentation. Performed primary source verification for both initial and recredentialing of designated healthcare providers. Follow up with providers to collect any missing or additional information required for successful credentialing. Perform a CAQH data verification every three months, keeping providers updated on any compliance renewal or update needs. Any instance of provider malpractice will be flagged as Red Flag to the Cred Committee. Input provider application information into a tracking system and carry out the necessary vetting processes. Follow up with providers to collect any missing or additional information required for successful credentialing. Alerts created in Software to obtain the missing information within 72 hours of time. Every three years, providers must complete the recredentialing process. Ensure that the provider details are up to date entered into the Symplr Software. Any updated information received will be entered into the Provider record immediately with attachment of the documentation. Consistently communicated with providers to address any support needed for their documentation. CORE QUALIFICATIONS ICD-9 and ICD-10 Coding. HMOs and Medicare. Operations Management. CPT and HCPCS Coding Medical Billing Medical Records Management Patient Confidentiality SKILLS OMEGA HEALTHCARE SERVICES MAR 2021 - MAY 2022 Senior Executive - AR Grade II Initiate telephone calls to insurance companies requesting the status of claims in the queue. Contact insurance companies for further explanation of denials and underpayments. Take appropriate action on claims to guarantee resolution. Ensure accurate and timely follow-up where required. Meet weekly with Billing Account Liaisons to discuss the status of accounts sent for review and to report reoccurring denial exceptions Improve knowledge on Medical Billing software, Arability, and clearinghouse. Improve skills on CPT codes and DX Codes PROJECTS/SOFTWARES Greenway Health - Multi speciality Greenway Health - Cardiology Greenway Health HCN Montifier Newyork University project - EPIC software Project Management Public Relations SITCO Teamwork International Consultant - Online Sales Time Management Leadership Effective Communication Critical Thinking Sales Conversion of leads from proposal. Dealing with existing clients. In responsibility of posting products in site. Taking Skype call with clients on their requirements. Regular follow ups on emails VALAM CHEMICALS AREA OF EXPERTISE Supervising Staff Strategic Planning Managing Process Conflict Management Staff Motivation Decision Making NOV 2020 - MAR 2021 APR 2019 - MAY 2020 HR Executive Implementing HR policies and procedures and compliance matters. Schedule meetings, interviews and conduct orientation to faster positive attitude towards organizational objectives. Managed employee access cards and troubleshoot problems with cards and/or system. Sourced, interviewed, hired qualified candidates & negotiated offers and closed hires. Ensured company compliance with state and federal regulations. Analyzed process gaps in the performance management system and adopted improvement measures. Delegating Work SBL KNOWLEDGE SERVICES LTD JAN 2018 - DEC 2018 International Sales - Business Development Responsible for generating new prospects by interacting with existing and prospective customers. Sourcing new sales opportunities through lead-follow up and outbound calls and emails with international customers. Handling new client enquiries and acting as the face of the business. Understanding customer needs and requirements. Team with channel partners to build pipeline and close deals. Archive quarterly and annual sales target. Implementing HR policies and procedures and compliance matters. LANGUAGES English (Fluent) Hindi (Fluent) Tamil (Fluent) Arabic (Basics) Schedule meetings, interviews and conduct orientation to faster positive attitude towards organizational objectives. Managed employee access cards and troubleshoot problems with cards and/or system. Sourced, interviewed, hired qualified candidates & negotiated offers and closed hires. Ensured company compliance with state and federal regulations. Analyzed process gaps in the performance management system and adopted improvement measures. ORCHESTRATE HR PVT SOLUTIONS FEB 2012 - JUNE 2017 Department Supervisor Medical Billing Medical Coding AR Collections Payment posting Demonstrating and understanding insurance types to make complete payments without any denials or omissions or over payments. Reviewing and evaluating patient records for appropriate handling regardless of age, status or payer. Follow up on past due invoices and delinquent accounts to reduce number of unpaid and outstanding balances. Document patient data and medical records, and perform routine medical record audits to comply with insurance company requirements. Uphold and reinforce compliance with hospital policies and federal regulations such as HIPAA. I hereby declare that the above written particulars are true and correct to the best of my knowledge and belief. Afreen Fathima Bijli Z