Gomathi Gomu

Detail-oriented Medical Billing professional with 2 years of experience in the US healthcare revenue cycle. Skilled in patient demographics entry with 1 year of hands-on experience, along with foundational knowledge in charge entry using CPT and ICD codes. Brings 1 year of dedicated experience as a Patient AR Analyst, specializing in denial management including eligibility-related denials, coordination of benefits, and payer-specific rejections.

Proven ability to follow up on outstanding claims, resolve billing discrepancies, and support timely reimbursements across multi-state insurance accounts.

Demographics & Charge Entry Executive - Saisystems Healthcare - Chennai, India

• Accurately entered and maintained patient demographics and insurance information in practice management systems, ensuring data integrity for smooth billing workflows.
• Supported charge entry process with foundational knowledge of CPT codes, ICD-10 diagnosis codes, and modifiers; organization utilized an automated charge-posting system.
• Performed insurance eligibility verification through online portals and payer websites, reducing eligibility-related denials at point of service.
• Successfully handled accounts spanning multiple US states, demonstrating knowledge of varied state-specific payer rules and regulations.

Patient AR Analyst & Eligibility Denial Specialist - Saisystems Healthcare - Chennai, India

• Managed end-to-end patient AR follow-up, consistently reducing outstanding balances by identifying billing discrepancies and escalating unresolved claims.
• Conducted systematic claim tracking and follow-up with insurance payers to ensure timely reimbursements and minimize revenue leakage.
• Resolved complex denial codes including CO-16 (missing/incomplete information), CO-22 (coordination of benefits), CO-27 (expenses incurred after policy termination), and CO-109 (not covered by this payer) through accurate appeal submissions.
• Managed eligibility-related denials (CO-26, CO-27, CO-109) — verified active coverage, corrected patient/insurance details, and resubmitted claims.

Bachelor of Commerce - B.Com - Sir Theagaraya College

Higher Secondary Certificate - HSC - St. Paul's Mahajana Higher Secondary School

Secondary School Leaving Certificate - SSLC - St. Paul's Mahajana Higher Secondary School