• Verify patients' insurance coverage and benefits by collecting and reviewing insurance information, including policy numbers, group numbers, and coverage limitations • Researching insurance plans and benefits to determine coverage for specific medical services • Ensure that all documentation follows healthcare regulations, privacy laws (such as HIPAA), and internal company policies regarding data handling and patient information confidentiality • Maintain detailed records of insurance verifications, coverage details, and communication with patients and insurance providers • Coordinate with healthcare providers, billing departments, and insurance companies to ensure accurate billing and claims submission • Assist in resolving insurance-related issues, such as claim denials, coverage disputes, and coordination of benefits • Promoted a positive work environment by fostering teamwork, open communication, and employee recognition initiatives • Enhanced overall team performance by providing regular coaching, feedback, and skill development opportunities • Established clear performance metrics for the team, which helped in tracking progress towards set targets effectively • Coached team members in techniques necessary to complete job tasks • Influenced positive change within the organization through strategic thinking, innovation, problem-solving abilities, and consistent leadership style • Increased customer satisfaction by ensuring timely completion of projects and adherence to high-quality standards • Evaluated employee skills and knowledge regularly, training, and mentoring individuals with lagging skills.

- Verification of Benefits, Eligibility, Authorization, and Claims. - Patient calls for copay and financial responsibility. - Inbound calls from Patients, Insurance, Doctors' Offices, and Surgical Facilities. - Booking Sheets Labelling & Sorting in shared data folders. - Credit card payment collection from patients. - Email Escalations, Issues, Info, and Correspondence with peers and other teams. - Book appointments as per booking sheets and Daily Activity Report. - Consistently met or exceeded performance metrics, showcasing dedication to high-quality work output. - Managed multiple tasks simultaneously while maintaining focus on deadlines and deliverables. - Ensured compliance with industry regulations by staying informed about changing guidelines and updates within the field of verification services. - Enhanced the quality of verifications by conducting comprehensive research and investigation into applicant backgrounds. - Maintained strict confidentiality of sensitive client information, adhering to company policies and regulations.

- Verification of Eligibility, Authorization Requirements, Initiating New, Retro Authorizations and Appeals. - Enhanced departmental efficiency with thorough knowledge of insurance guidelines and medical terminology. - Conducted regular audits of authorization records to verify accuracy and adherence to regulatory requirements, minimizing risk of noncompliance. - Optimized workflow processes through effective communication between departments regarding authorization needs and statuses. - Reduced processing times by effectively managing a high volume of authorizations, referrals, and appeals.

- Check account information for eligibility with program plans and guidelines.- Contact insurance companies in USA like (BCBS, UHC, AETNA, HUMANA, MEDICARE & Medicaid) to get patient's eligibility and benefits.- On behalf of Provider/Doctor we gather the information related to Medical Drugs, Adminsitration & Office Visit for Osteoarthritis of the knee.- Information is saved through online portals i.e Deductible, Out of Pocket Max, Co-insurance, Co-pays, and Timely Filing etc.- Network Status, Effective Date, Plan type (HMO, POS, PPO), Plan Name/Formulary, Self/Fully Funded, Employer/Group Name, Guidelines Cost Share / Benefits.- Co-insurance, Co-pays, Deductibles, Out-of-pocket Max, Prior Authorizations / Pre-Certifications / Pre-Determination, Timely Filing to submit claims, Claims Mailing Address, BNB (Buy & Bill), Medical Notes, Referrals Insurance Types- Medicare, Medicaid, Commercial, Market Place, Federal Plans, State Health PlansInsurance Companies- BCBS (Blue Cross Blue Shield) all states- FEP (Federal Employees Program)- BCN (Blue Care Network) Michigan Only- UMR (United Medical Resources)- UHC (United Healthcare) all states- AETNA- CIGNA- HUMANA

- To achieve sales targets through franchise channel. - Ensure implementation of effective and efficient Customer Relationship Management in assigned franchise by creating good working relations with franchise owners / staff.- Follow ups and ensure that franchise in-house operations are standardized and synced with other Customer Services channels by ensuring compliance to predefined standards, Company / Regulatory Bodys policies and procedures. - To remain abreast on all current policies, procedures, promotions, products, and value added services offered by the company.- To observe and coach franchise staff members on customer handling skills based on gaps identified during visits and nurture the team members.- Act as focal point for all in-house issues of the assigned franchises and co-ordinate with back end support departments to ensure timely rectification of their highlighted issues.- Recommend areas and concerns pertaining to existing policies and processes where re-engineering is required.- Ensure proper behavior/ discipline/ grooming/ punctuality of self and franchise staff as per the company requirements and image through evaluation of all staff members in monthly visits.

- Answer calls and respond to customer requests regarding product & services.- Handle customer inquiries related to product and services.- Manage and resolve customer complaints.- To remain abreast on all current policies, procedures, promotions, products, and value added services offered by the company.- Identify and escalate the issues through CMS (Complaint Management System).- Route calls to appropriate resource where necessary.- Ensure proper behavior/ discipline/ grooming/ punctuality as per the company requirements.