Subha Maghi

US Healthcare Revenue Cycle Management (RCM) professional with approximately two years of experience as a Senior Client Partner at Access Healthcare, specializing in Prior Authorization, eligibility verification, medical records review, and provider communication. Experienced in following SOPs, protecting confidential patient information in accordance with HIPAA requirements, and meeting established quality and SLA targets. Contributed to the team’s handling of a new process introduced by the team.

Senior Client Partner – US Healthcare RCM - Access Healthcare - Chennai

(2024-10)

• Prior Authorization: Process authorization requests by reviewing patient demographics, insurance details, diagnosis codes, CPT codes, service dates, and supporting medical records in accordance with established SOPs.
• Eligibility Verification: Verify patient eligibility and insurance information to support accurate authorization processing.
• Medical Records Review: Review medical records and discharge summaries when required for authorization processing and maintain accurate case documentation.
• Provider Communication: Contact healthcare providers to clarify demographic discrepancies and confirm patient admission or discharge status when required.
• Census Management: Perform census calls to verify and update patient in-house and discharge status.
• HIPAA Compliance: Follow HIPAA requirements when handling confidential patient information and maintain data confidentiality.
• Denied Authorization Processing: Handle inpatient and outpatient denied authorization cases by reviewing denial reasons, medical necessity, provider network status, and duplicate cases. Route eligible cases to the Appeal Department, process reopening requests for inpatient emergency cases within the seven-day timeframe according to SOP, and send return memos to providers for cases that do not meet the reopening criteria.
• New Process Support: Support the processing of a new workflow introduced by the team, adapting to process requirements and following the applicable SOPs.
• Dane Street Process: Learned the new client process through client training calls and currently handle emergency inpatient and outpatient psychiatric authorizations as part of the team, maintaining accuracy and error-free processing.
• SLA and Quality: Manage assigned cases while consistently meeting established productivity, quality, and SLA targets.
• Handled inbound calls(semi voice process) and updated authorization accurately productivity and quality standards while handling multiple authorization
• In-Market Case Processing: Reviewed medical records attached to cases associated with previously closed inpatient authorizations to verify the member’s current admission or discharge status.
• Authorization Reopening: Reopened closed inpatient authorizations and routed them for Concurrent Review when medical records and verification confirmed that the member was still admitted and receiving treatment at the facility.
• Discharge Processing: When the member was discharged, reviewed the medical records and confirmed the discharge status, updated the discharge date and disposition in the discharge tab, and resolved the case according to SOP.
• Case Documentation: Updated the required case details accurately and ensured appropriate case resolution based on the member’s verified status.
• Received client appreciation for quality performance in Prior Authorization services.
• Contributed to the team's successful handling of a new Dane Street process through accurate processing and teamwork
• Recieved star of the business award for Top performer in month

B. Com - Marketing Management - Anna Adarsh College for women (2024)