Adhir Ahire

Eligibility Verification Specialist –

• Checking patient insurance coverage and benefits.
• Confirming policy details with payers before services.
• Handling eligibility, claims, and billing accuracy.
• Verifying eligibility during admissions, or scheduling.
• Verified patient eligibility and insurance coverage with 95–98% accuracy.
• Familiar with Medicare, Medicaid, and private insurance processes.
• Experienced with healthcare software (FrontRunner, Navinet, Availity, or payer portals).

• Processed high volume of incoming claims, ensuring compliance with established policies and procedures.
• Verified correctness of claim data prior to processing, reducing errors and ensuring accurate claims management.
• Adhered to all applicable laws, regulations, and company standards while processing claims.
• Process claims with 99% productivity and quality.

• Processed various claims, including COB, corrections, and authorizations, ensuring accuracy and compliance.
• Achieved production and quality service level agreements (SLAs) through diligent monitoring and management.
• Researched and followed up on denied insurance claims.
• Reviewed and validated documentation for denied and accepted insurance claims, ensuring thoroughness and adherence to guidelines.

• Resolved customer complaints in a timely manner while maintaining professional attitude.
• Performed follow-up calls to customers regarding their inquiries or orders.
• Assisted with customer inquiries related to product information, order status, returns and exchanges, billing issues and more.
• Ensured that all customer queries were handled quickly and professionally.
• Responded to customer inquiries via phone to provide assistance.
• Monitored customer feedback regularly to identify areas for improvement in services offered.
• Explained benefits and advantages of different product and service offerings to customers.