Senior Associate - ELICO HEALTH CARE PVT LTD - Hyderabad, India
(2023-06)
- Have experience in PAYMENT POSTING and DEMOGRAPHIS for Client Medicount
- Planning of work Allocation as per the priority, Auditing the claims posted by the Associates and making the needful Corrections
- Maintaining the Quality to meet the Production standards within TAT on daily basis
- Posting payments in patient's accounts and verifying the medical insurance by eligibility verification through Waystar and Availity
- Well versed with the Co-pay, Co-insurance, Deductible, EOB and COB
- Having experience in Charge Entry and Charge Posting
- Creating the Demographics and posting the charges to the patient account
- Worked on patient responsibilities by checking patient details in IDICORE for patient's identity verification
- Worked on various clearing houses like Waystar and Availity
- Having knowledege in CMS 1500 & UB 04 Claim forms
- Worked on charge and demographic entry, Worked on clearing house rejections
- Auditing the claims posted by the Associates and making needful corrections
- Analyzing the claims to meet the quality required by the client
- Posting payments to patient's accounts and verified medical insurance
- Analyzing Patient Responsibilities and billing to insurance by eligibility verification
Analyst - R1RCM - Hyderabad, India
(2022-06 - 2023-05)
- Creating and Posting the Charges manually in system within TAT on daily basis
- Checking patient Eligibility
- Production Consolidation
- Trained the new team members on the process
- Data Verification, performed according to quality targets
- Identifying issues and intimating to supervisor for clarifications
- Maintains production and quality
- And also have experience in Claim Adjudication
Supported Father Business - Self-Employed - Hyderabad, India
(2020-05 - 2022-05)
Senior Associate - Optum (UHG) - Hyderabad, India
(2015-10 - 2020-04)
OHFS CDH (Optum Health Financial Services Consumer Driven Healthcare) and OPI (Optum Payment Integrity) (FWAE Claims)
- Handled HRA and FSA account claims
- Adjudication of the documentation and approving the claim as per the guidelines of the process
- Handling High Dollar claims, and Performance Guarantee claims and auditing of the claims as well
- Worked on CPW application (Claims Process Workstation)
- Given appropriate reason codes which are suggested by Clinical Investigation Team, Intake and Escalations
- Re-entered the claims with the Data entry verification of the provider
- Re-process the claims not only for correct payment, but also to communicate the results of the Fraud Waste Abuse and Error – (FWA & E) audit to the providers
- Re-entering and Processing Claims on the daily basis working on escalation queue and correcting the errors which are received from onshore
- Validate and clear all the manual and system reviews on the daily and weekly basis so that the claim is processed with payment and denial reason codes
- Received 1 Star award Associate of the quarter
- Have received appreciations from Manager & Leads
- Have successfully completed given tasks, projects & training for new associates within given Time & SLA
- Have Implemented many values adds for the process improvement
