Sr Tech support Analyst - Optum Global Solutions - Hyderabad
(2024-04)
Responsible for supporting customers with all back end Optum applications, Client applications and 3rd Party Vendor support. Need to address and responding to customer inquiries through ticketing system Sales force and addressing issues and functional enhancements for the assigned applications or customer developed solutions.
- Technical Supporting for various billing products eFRB/MS4 & Experience in UAT (User Acceptance Testing)
- Coordinating with Stakeholders, Reimbursement team, Patient Access, Patient Financial services teams for gathering information and Maintain users, specific profiles and tables in eFRB/MRT/CA/MS4 Products and applications
- Good understanding of RCM, Transformation & Technology Orientation
- Good understanding of relational databases, database structures
- Coordinate with Stakeholders and other business partners for gathering information
- Responsible for trouble-shooting complex issues, ability to analyse data and to present analysis in a format that is relatable to interested parties
- Monitors and responds to assigned work queues and assists in prioritizing and resolving user tickets and Coordinate testing and post-production validation to ensure efficient services and optimal system development
- Strong understanding of EMR, EHR files & Working knowledge of SQL
- Coordinating all task that are required with other teams to ensure the changes are implemented and tested in these applications
Recovery/Resolution Analyst - Optum Global Solutions - Hyderabad
(2022-02 - 2024-04)
Responsible for performing comprehensive research when reviewing provider appeals or disputes on previously identified overpayments using COSMOS and UNET platforms.
- Investigate, research, and analyse claims data, applying knowledge of medical or pharmacy policy to determine validity of the overpayment in accordance with all applicable guidelines and policies
- Reviewing of CMS guidelines, Team Tracks and Reimbursement policies
- Collaborating with Policy owner/Team Track owners /Other business partners for accurate determination of Overpayment Claims
- Provide documentation for all requested claims adjustments consistent with Medical Claim Recoveries Documentation Requirements
- Root Cause Analysis on historic provider appeals and possible remedies to control Provider appeals
- Experience analysing large data sets to determine trends / patterns and analysis of business processes and workflows
Subject Matter Expert - Optum Global Solutions - Hyderabad
(2020-10 - 2022-02)
Supported Equian IBR project as SME for IBR project for Empirical product. Part of this project from Application integration. Played key role in Application integration, Application Migration, Testing and postproduction issues.
- Coordination with Technical Developers, Architects, business teams and other project team members on Enhancements, implementation, and evaluation of learning solutions from the process standpoint
- Good experience in user acceptance tests and coordinate with technical consultants for getting them fixed before deployment
- Suggest the desired enhancements to meet the process requirements
- Preparing Job aids and document the steps and ensure timely updates are made to the process documents
- Project management and people management real time experience
- Support individuals through the training program and on the floor by providing immediate feedback on work performed
- Serve as a subject matter expert to clarify policies and procedures and provide information on observed trends and additional training opportunities
- Assist with Quality Review Process, Assist the training department on additional classes or material for training purposes and assist other team members in process knowledge
Quality Specialist - Optum Global Solutions - Hyderabad
(2016-05 - 2020-05)
Have Supported United Data mining project for M&R.
- Review the Paid Claims by following the SOP's, Policy Guidelines and Reimbursement policies
- Good understanding of adjudication platforms like COSMOS, NICE, FACETS and UNET platforms
- Reviewing the Provider paper contracts for checking contract rates and amounts
- Perform complex claims analysis and audit activities to identify trends, determine root cause of payment inaccuracies, and to recommend / implement process and systems improvements
- Have transitioned Multiple Algorithms successfully and trained multiple batches in different Algorithms
- Collaborating with Onshore SMEs for clarification
- Worked with multiple applications to determine the claims outcome and process improvement ideas
Claims Associate - Optum Global Solutions - Hyderabad
(2013-02 - 2016-05)
- Accurate auditing and completion of international medical claims (HCFA 1500, UB92 & member claims) within turnaround standards
- Good experience in adjudication of both Hospital and Physician claims in different platforms
- Responsible for the adjudication of claims by following standard operational procedure (SOPs), Validating Provider selection, Member selection, Assignment benefits and Member benefits
