Sr. Executive AR - THARWORX (Optimize RCM)
(2020-07 - 2026-07)
- Taking Inventories.
- Review claims that have not been paid by insurance companies.
- Follow up with insurance companies to understand status of claims. Follow up is done through insurance company/ Third- party administrator (TPA) website or through outbound calls.
- Constantly keep track of both electronic and paper claims.
- Created login credentials with Insurance carrier for team.
- Working on any major rejections or denials – clearing house/carrier.
- Prioritize the pending claims for calling from the aging basket.
- Analyze patient's records and medical history.
- Client communication, requirements gathering.
- Daily Monitoring of all ops jobs to ensure they succeed
- Analyze required documents.
- Prepare a document containing statements those need to be clarified.
- Knowledge transfer with other team members to improve overall team education level
- Verify solutions that meets the requirements
Sr. Executive AR - ACN Healthcare RCM Services Private Limited
(2019-05 - 2020-06)
- Client communication, requirements gathering.
- Daily Monitoring of all ops jobs to ensure they succeed
- Analyze required documents.
- Prepare a document containing statements those need to be clarified.
- Knowledge transfer with other team members to improve overall team education level
- Verify solutions that meets the requirements
- Help team to maintain Quality of work.
- Conducting TNA (Training Need Analysis) to the team.
- Sharing Quality Report with the team on weekly basis.
- Provide data to generate team performance metrics
- Maintaining all updates and share it with the team as per client requirement.
- Provide accurate and timely information and escalates when there are issues
- In case the claim gets denied, taking denial reason and need to see whether we can fix the denial while on the call with the Insurance Carrier. If that is not viable option, then need to note the reason for the denial and pass it on to the appropriate department.
- Doing appeals through paper, or through fax mode, as per the requirement of Insurance Carrier in timely manner.
- Constantly keep track of both electronic and paper claims.
- Created login credentials with Insurance carrier for team.
- Working on any major rejections or denials – clearing house/carrier.
- Prioritize the pending claims for calling from the aging basket.
- Analyze patient's records and medical history.
- Checking the appropriateness of the insurance information given by the patient if it is inadequate or unclear.
- Working on all queues (As per the client requirement).
- Working on outstanding claims and initiating collection (patient co-pay, co-insurance, deductible, etc) as per aging report.
- Reviewing EOB, posting the denials and taking appropriate action on the denials.
- Understand Insurance rules and regulations.
- Prepare the necessary claims documents requested by insurer.
- Negotiating and building healthy relations with insurance company.
- Reviewing and correcting the denied claims.
- Maintaining the records relating to medical billing.
- Constantly watch-out for payments and EOBs from major carriers, Pay-to-address, provider numbers etc.
- Ensuring the compliance with all the insurance carriers in claims submission and other areas.
- Helping trainees and make them to get graduate in timely manner (As per management standards).
- Preparing weekly and monthly reports.
- Achieving production and quality on daily basis.
Reimbursement Specialist - Pradot Technologies Private Limited
(2018-03 - 2019-05)
Achievements: Always completed work on time. Appreciated for taking initiative and moved client from red flag. Appreciated for maintain smooth work flow. Graduated (in the given time frame).
- Taking Inventories.
- Review claims that have not been paid by insurance companies.
- Follow up with insurance companies to understand status of claims. Follow up is done through insurance company/ Third- party administrator (TPA) website or through outbound calls.
- In case the patient does not have sufficient insurance coverage for the medical procedure or if the patient is in any way not eligible for coverage, transfer the outstanding balance to patient.
- In case the claim has already been paid by the insurance company, request insurance company/ TPA to send EOB (Explanation of Benefits) through fax/mail.
- In case the claim gets denied, taking denial reason and need to see whether we can fix the denial while on the call with the Insurance Carrier. If that is not viable option, then need to note the reason for the denial and pass it on to the appropriate department.
- Doing appeals through paper, or through fax mode, as per the requirement of Insurance Carrier in timely manner.
- Constantly keep track of both electronic and paper claims.
- Created login credentials with Insurance carrier for team.
- Working on any major rejections or denials – clearing house/carrier.
- Prioritize the pending claims for calling from the aging basket.
- Analyze patient's records and medical history.
- Checking the appropriateness of the insurance information given by the patient if it is inadequate or unclear.
- Working on all queues (As per the client requirement).
- Working on outstanding claims and initiating collection (patient co-pay, co-insurance, deductible, etc) as per aging report.
- Reviewing EOB, posting the denials and taking appropriate action on the denials.
- Understand Insurance rules and regulations.
- Prepare the necessary claims documents requested by insurer.
- Negotiating and building healthy relations with insurance company.
- Reviewing and correcting the denied claims.
- Maintaining the records relating to medical billing.
- Constantly watch-out for payments and EOBs from major carriers, Pay-to-address, provider numbers etc.
- Ensuring the compliance with all the insurance carriers in claims submission and other areas.
- Helping trainees and make them to get graduate in timely manner (As per management standards).
- Preparing weekly and monthly reports.
- Achieving production and quality on daily basis.
Accounts Receivable Executive - SysInformation Healthcare India Pvt Ltd
(2016-11 - 2017-12)
Achievements: Always completed work on time. Appreciated for maintain smooth work flow. Graduated (in the given time frame).
- Taking Inventories.
- Review claims that have not been paid by insurance companies.
- Follow up with insurance companies to understand status of claims. Follow up is done through insurance company/ Third- party administrator (TPA) website or through outbound calls.
- In case the patient does not have sufficient insurance coverage for the medical procedure or if the patient is in any way not eligible for coverage, transfer the outstanding balance to patient.
- In case the claim has already been paid by the insurance company, request insurance company/ TPA to send EOB (Explanation of Benefits) through fax/mail.
- In case the claim gets denied, taking denial reason and need to see whether we can fix the denial while on the call with the Insurance Carrier. If that is not viable option, then need to note the reason for the denial and pass it on to the appropriate department.
- Doing appeals through paper, or through fax mode, as per the requirement of Insurance Carrier in timely manner.
- Constantly keep track of both electronic and paper claims.
- Created login credentials with Insurance carrier for team.
- Working on any major rejections or denials – clearing house/carrier.
- Prioritize the pending claims for calling from the aging basket.
- Analyze patient's records and medical history.
- Checking the appropriateness of the insurance information given by the patient if it is inadequate or unclear.
- Working on all queues (As per the client requirement).
- Working on outstanding claims and initiating collection (patient co-pay, co-insurance, deductible, etc) as per aging report.
- Reviewing EOB, posting the denials and taking appropriate action on the denials.
- Understand Insurance rules and regulations.
- Prepare the necessary claims documents requested by insurer.
- Negotiating and building healthy relations with insurance company.
- Reviewing and correcting the denied claims.
- Maintaining the records relating to medical billing.
- Constantly watch-out for payments and EOBs from major carriers, Pay-to-address, provider numbers etc.
- Ensuring the compliance with all the insurance carriers in claims submission and other areas.
- Helping trainees and make them to get graduate in timely manner (As per management standards).
- Preparing weekly and monthly reports.
- Achieving production and quality on daily basis.
US-IT Recruiter - US-IT Recruiter (Freelancer)
(2015-10 - 2016-07)
- Source, interview, and select applicants for technical positions.
- Meet with hiring managers to determine job duties.
- Match applicants to job openings.
- Source for future job openings.
- List job postings on job boards, social media, corporate career web sites, and other possible channels.
- Call applicants and perform phone screens.
- Instruct applicants on the nature of the job and whom they will be speaking with during the interview.
- Facilitate meeting between hiring manager and applicant.
- Hand out and grade assessments.
- Check references.
- Informing candidate of company's decision.
- Keep track of all applications file away important notations such as gender, race, and ethnicity.
- Participate in implementing new recruiting technology, such as applicant tracking systems and screening tools.
- Maintaining the SLA (Service Level Agreement).
- Taking resumes on Priority.
- Following up with the resumes.
- Taking the ownership of the clients and solving the problems at the earliest.
- Preparing Daily & Monthly Reports.
- Replying to E-mails and putting reminders.
Service Desk Executive - Wipro Infotech Metagalli Mysore - Mysore
(2014-09 - 2015-06)
- Maintaining the SLA (Service Level Agreement).
- Taking cases on Priority.
- Coordinating with the remote Engineers (N&S and P&S).
- Coordinating with the Network and Security Engineers and Platform & Storage Engineers (Field Engineers).
- Coordinating with the Pan India stores.
- Allocation of Engineers for the scheduled planned activities.
- Taking approvals from PM (Project Managers) to move the spare through flights and Cabs from one place to another place (Entire Pan India).
- Following up with the spares.
- Taking review about the scheduled night activities.
- Taking handovers and resolving the issue at the earliest.
- Handling the Customers Queries.
- Providing good service with quick resolution.
- Maintaining the Calls Quality & Service level.
- Taking the ownership of the customer and solving the problems.
- Satisfy the customer with good resolutions.
- Handling Conference Calls.
- Handling Escalation Calls.
- Preparing Daily & Monthly Reports.
- Replying to E-mails and putting reminders.
- Ability to convince the customer with resolution.
Customer Relationship Officer (IT-Help Desk) - Infosys Technologies Pvt Ltd Mysore - Mysore
(2013-02 - 2014-09)
- Handling the Customers Queries.
- Providing good service with quick resolution.
- Maintaining the Calls Quality & Service level.
- Taking the ownership of the customer and solving the problems
- Satisfy the customer with good resolutions.
- Handling Conference Calls.
- Handling Escalation Calls.
- Preparing Daily & Monthly Reports.
- Replying to E-mails and putting reminders.
- Ability to convince the customer with resolution.
- Helping trainees and make them graduate in timely manner.
