Avinash Chavan Email & Phone Number

I bring extensive experience in managing and processing health-related insurance claims. With a strong focus on accuracy, efficiency, and regulatory compliance, I excel at navigating complex healthcare systems and ensuring policyholders receive the coverage they are entitled to. My key areas of expertise include:- **Claims Processing & Adjudication:** Efficiently processing medical claims from submission to resolution, verifying claim accuracy, and ensuring they meet policy guidelines and legal standards. - **Medical Coding & Billing:** Expertise in interpreting medical records, using ICD-10, CPT, and HCPCS codes to review and approve claims while ensuring compliance with healthcare coding standards.- **Claims Investigation & Appeals:** Conducting thorough reviews of disputed or denied claims, analyzing medical documentation, and working with providers and policyholders to resolve issues and ensure accurate adjudication.- **Customer Support & Advocacy:** Providing clear guidance to policyholders on coverage, claims status, and benefits, resolving inquiries, and advocating for fair and timely claim settlements.- **Regulatory Compliance:** Staying updated with healthcare regulations, such as HIPAA and the Affordable Care Act, to ensure all claims handling aligns with the latest standards and practices.- **Coordination with Providers:** Collaborating with healthcare providers, insurers, and other stakeholders to expedite claims processing and resolve discrepancies.### **Key Skills:**- Medical claims review and adjudication- Medical coding and billing (ICD-10, CPT, HCPCS)- Claims appeals and disputes resolution- Regulatory compliance (HIPAA, ACA)- Healthcare systems and software (Epic, Cerner)- Customer service and communication- Data analysis and fraud detection---This profile emphasizes expertise in medical coding, regulatory compliance, and claims processing, essential for professionals in health insurance claims roles.

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  Sinhgad Technical Education Societys Smt. Kashibai Navale College Of Pharmacy, Kondhawa Bk.,Dist.Pune 48

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