Mohammed Faisal Mohammed Riyaz Shaikh

Sr. Revenue Cycle Specialist

• Job Details:Managed claim denials, accounts receivable and insurance claims processing for US-based healthcare providers like Penn Highlands Healthcare and Massachusetts General Hospital and Physicians Organization. Proficient with federal payers like Medicare and Medicaid, as well as a variety of commercial payers including Cigna, Aetna, and UHC. Experienced in professional billing and hospital billing on the claim forms like CMS-1500 and UB-04. Foundational knowledge in processing and resolving worker's compensation and motor vehicle act insurance. Utilized Epic, Cerner and ECW and other tools and software to ensure accurate and efficient claim billing. Ensured all the re-submissions of fresh claims, corrected claims, first-level reconsiderations and final-level appeals were completed within the TFL. Communicated with the insurance to resolve denials in trends for high dollar value claims and worked on e-mail escalations if received. Assisted the teams which were designed for appeals submissions, charge postings & claim rejections. Assisted the team by assigning daily or weekly allocations, ensuring the team resolves claims on a priority basis and reporting back to upper management. Trained new joiners about basics of RCM, claim denials & software, provided floor support to the juniors and assisted in inventory management.