Overall, 11 years of experience in US healthcare including Medical coding and DME billing.
DME billing- Order entry, Medical coding, Eligibility verification, estimating patient responsibility, Criteria review, Prior Authorization, Retro Authorization, follow ups, Payer paperwork compliance, Clean claim review, Claim submission, EDI rejections, Claims adjudication, Denials and appeals.
Analytics- Clean claim ration, Cycle time of claim, DSO, AR ratio, AR aging, billing trends.
Medical coding: HCPCS, ICD 10 CM, E/M, ED, Pathology, Radiology, HCC coding.
Preparing and presenting project metrics and dashboards to client and internal leadership.
Identify claim EDI rejections, Payer denials, Clearing house submissions and write offs.
Communicating issues with Project owners and discussing RCA and CAPA.
Helping team Projects to exceed client expectations.
Liaise between front end and back-end team in US healthcare RCM cycle to increase first pass yielding, controlling EDI rejections and Denials.
Payer policies implementation in operations and software’s. Interacting with IT team for better software implementations.
Liaise between client and offshore team to understand, refine, and manage project expectations.
CPC (Medical coding certificate) and TTT certified (FACET), Training new hires, BQT, Refresher trainings, keep on updating team in operations and Skill ups.
Stakeholder’s management, interacting with on field team (US) to work on real time challenges and resolving operational issues.
Identifying process gaps and working on them until closer
