Koncha Jaya Laxmi

Experienced healthcare professional with 2 years and 10 months of overall experience in the healthcare domain, specializing in claims processing, prior authorization, denial management, and appeals handling. Skilled in reviewing insurance requirements, identifying denial reasons, and preparing accurate appeal submissions with appropriate clinical and billing documentation. Proficient in working on end-to-end revenue cycle management (RCM) processes, ensuring timely resolution of claims, and improving reimbursement outcomes.

Strong understanding of payer guidelines, authorization workflows, and denial prevention strategies with a focus on accuracy, compliance, and process efficiency.

Sr Process Associate - Fax Intake Coordinator (Prior Authorization) - Thryve Digital Health LLP - Hyderabad, India

(2025-07)

• Review and analyze incoming fax documents related to Prior Authorization requests.
• Understand and interpret medical terminology and clinical information on each page of the fax.
• Identify the type of fax and route or process it accurately as per authorization guidelines.
• Ensure prior authorizations are completed within defined Turnaround Time (TAT).
• Maintain high accuracy and compliance while handling high-volume fax intake.
• Coordinate with internal teams to resolve missing or unclear information.
• Managed denial handling and appeal workflows for rejected authorization requests.

Claims & Prior Authorization Associate - Medicare - Carelon Global Solutions - Hyderabad, India

(2023-02 - 2024-11)

• Responsible for the accurate processing, keying, and adjustment of medical and Medicare health claims in accordance with claims policies and procedures.
• Evaluated medical necessity, clinical documentation, and payer requirements to review and process Prior Authorization requests.
• Demonstrated strong operational understanding of multiple healthcare products, including HMO, PPO, and Coordination of Benefits (COB).
• Applied comprehensive knowledge of benefit contracts, pricing policies, government regulations, and healthcare terminology.
• Manually processed fallout claims from system picks within strict Turnaround Time (TAT) standards.
• Discussed and analyzed critical and common process errors found in the process, suggesting effective workflow updates and denial prevention strategies.
• Successfully achieved and exceeded monthly production and accuracy targets, demonstrating strong efficiency and dedication to continuous improvement.

Bachelor of Computer Science - Computer Science - Dewan Bahadur Padma Rao Mudaliar Women's Degree & PG College (Osmania University) (2021-11)

Intermediate - MPC - Gowtham Jr. College (2018-04)

SSC (10th Class) - Holy Faith High School (2016-05)