Sumera G.
About Sumera G.
Sumera G. is a NCPDP AVA Benefits Claims Analyst Team Lead with extensive experience in healthcare claims analysis and management. She has worked in various roles across different organizations, demonstrating expertise in health insurance verification, claims auditing, and regulatory compliance.
Work at Option Care Health
Sumera G. has been employed at Option Care Health as an NCPDP AVA Benefits Claims Analyst - Team Lead since 2017. In this role, she leads a team of over four individuals responsible for verifying health insurance coverage from various payers, including Commercial, Medicare, and Medicaid plans. Her responsibilities include auditing PBM infusion and medical claims prior authorizations and appeals for specialty drugs to ensure correct coverage and reimbursements. She also coordinates incoming referrals and medical records with Clinician Technical Specialists and hospital staff, ensuring efficient processing of claims.
Education and Expertise
Sumera G. studied at Hillsborough Community College, where she earned an Associate of Science (AS) degree in English Language and Literature from 2011 to 2012. She also holds a Bachelor of Arts (B.A.) in Economics from the University of Karachi, completed from 1999 to 2001. Currently, she is pursuing a Bachelor of Science in General Healthcare and Information Technology at Colorado Technical University, which she began in 2013. Her educational background supports her expertise in healthcare management and claims analysis.
Background in Healthcare and Finance
Before her current role, Sumera G. worked in various positions that contributed to her extensive background in healthcare and finance. She served as a Credit Analyst at Union Bank in Pakistan from 1999 to 2005. In the United States, she worked as a Registered Pharmacy Technician at CVS Pharmacy from 2007 to 2011 and as a Medicare Part D Claims Analyst Team Lead at Freedom Health & Optimum HealthCare from 2012 to 2017. These roles provided her with a solid foundation in claims processing and customer service within the healthcare sector.
Achievements in Claims Analysis
In her current position at Option Care Health, Sumera G. reviews protocols, consent forms, R&D reports, and scientific documents related to clinical research projects to ensure compliance with regulations. She prepares detailed reports on project specifications, progress, and team activities. Additionally, she collaborates with various functions, including R&D, Clinical, Quality, and Manufacturing, to develop documents and responses to health authority inquiries. Her role is crucial in minimizing resource and time losses by addressing employee or production issues directly.