Pooja S

Program Specialist

Fortrea Inc(Labcorp)•  April 2022 - August 2024

Gained initial exposure to MYSQL in healthcare Domain metrics through routine data operations. Familiar with MySQL fundamentals, including database creation, running queries, basic data manipulation and extracting data for reporting purposes. Collaborated with cross-functional teams to identify opportunities for data-driven decision-making. Verified insurance coverage to confirm patient eligibility for prescribed therapy, ensuring prompt access to treatment, Cognizant of HIPPA Regulations. Finesse in Handling Patient Demographics and enrolling into PAP(Project of Gilead Sciences). Generated Excel reports utilizing VLOOKUP, Pivot tables and other functions for data analysis and decision-making. Utilized software applications like MYSQL, Siebel, Right Fax, Centrex, and NPPES Link to support program operations.

Program Representative

Fortrea Inc(Labcorp)•  September 2021 - April 2022

Maintained a professional, calm, and friendly demeanor, Expressed thoughts and instructions clearly in both verbal and written communication. Quickly and efficiently managed incoming faxes from program customers, identifying the nature of the request and documenting information accurately in applicable software systems. Merged duplicate patient faxes created, demonstrating attention to detail and organizational skills.

Associate Claims

Carleon Global Solutions (Legato Health Technologies)•  January 2018 - January 2021

Managed adjustment claims for Anthem across 14 states, ensuring accurate and timely processing. Handled various claim types, including Professional, Institutional, Medicare, and Medicaid. Demonstrated expertise in HMO, PPO, POS, and EPO plans, facilitating effective claim management. Successfully processed high-dollar claims exceeding $100,000 and assisted the team in achieving monthly targets. Provided audit support to nesting individuals for Claims and Adjustments, offering constructive feedback on errors. Collaborated with different teams to streamline inventory management processes, optimizing efficiency. Organized and hosted Fun Friday activities to promote team bonding and morale. Application software - CIW, Pega, WCF, EOC, Micro focus Reflection.