Priya Kumar

I have 3 years of experience in Claim Adjudication and Denial management. Strong Knowledge of claims processing and medical terminology. Ensured that all key metrics of performance were performed as per the client SLA. Solid history with the US Health industry.

Senior Process Consultant: Claim Adjudication - SAGILITY INDIA PRIVATE LIMITED

(2022-11)

• Working with claim adjudication which involves various steps of receiving claims.
• Resolving referral and authorization denials.
• Project on Medicare and Medicaid claims.
• Handling all kind of inpatient, outpatient and facility claims.
• Determining duplicate and corrected bills submitted by a provider.
• Verify provider status and active policy for the particular member in CAS.
• Maintaining Production and Quality as per SLA.
• Using Mentor Guidelines to solve the problems.
• Maintaining knowledge of all updates both related to process and from the client.
• Coordinating team for meeting and reviews for enhancement of quality.
• Buddy support to fresher.

BCA - Thirumurugan Arts & Science College (2019-06 - 2022-04)