Darunya Vivekanandan

Excellent reading comprehension skills in addition to written and verbal communication skills along with strong time management skills. Ability to work independently and multi-task in a fast paced environment review and post payments. Initiate authorization for outpatient and inpatient procedure.

Create claim for Office visit, surgery and also create batch for claim. Provide excellent customer service to patients and assist with inquiries regarding billing & collection issues. Review medical documentation and abstract procedure codes for billing purposes.

Review rejected and/or denied claims, make corrections and resubmit clean claim within the required time frame and if required appeal the claim with insurance companies to ensure maximum entitled reimbursement. Verify insurance benefits and assist patients with inquiries regarding billing. Accurately assign patients to diagnosis-related groups according to their charts and the designated treatments used for coding and billing.

Experience with insurance claim portals. Provide detailed billing reports of all procedures, prescriptions, and therapies used in the course of treatment. Reproduce correct insurance records and assign billing to the proper accounts as needed.

Working knowledge on IT Support from Networking to System Administration. Demonstrated ability to navigate Internet Explorer and Microsoft Office, including the ability to input and sort data in Microsoft Excel and use company email and calendar tools. Over 5 years of experience in Nursing and as nursing instructor.

Software knowledge – Athena, Epic, ECW, Civie, Prism, AI tool, Waystar, Availity, Excel, Microsoft teams & outlook.

Denial Specialist - Allyhealth Solutions

(2024-08)

• Research, analyze and respond to inquiries regarding compliance, inappropriate coding, denials and billable services.
• Report work time and work productions in a timely and accurate manner.
• Communicates with coworkers in an open and respectful a manner which promotes teamwork and knowledge sharing.
• At least 4 years of experience with accounts receivable software such as Prism, Epic and ECW, Cevie Radico.
• Demonstrated ability to meet performance objectives.
• Knowledge of Medicare, Medicaid, and commercial insurance plans along with IPA plan.
• Demonstrated experience with writing appeals, initiating appeals/follow-up on appeals.
• Experience identifying billing errors and resubmitting claims as well as following up on payment errors, low reimbursement and denials.
• Maintain QA percentages within two internal quality goals; 1) overall minimum coder accuracy of 95% and 2) QA review percentages.
• Maintain a continual knowledge of problems or issues that could affect review quality levels.
• Verifies accuracy of underpayments by researching contracts and claims data.
• Participate in corporate training and meetings.
• Provide daily account worked reports to the manager as requested.
• Identify the importance of documentation on code assignment and the subsequent reimbursement impact.
• Comply with all internal policies and procedures. Actively participate in Company provided training and education.
• Ensure individual compliance with all privacy and security rules and regulations and commit to the protection of all Company confidential information, including but not limited to, Personal Health Information.
• At least two years of experience in healthcare insurance accounts receivable follow up, working with or for a hospital/hospital system, working directly with government or commercial insurance payers.
• Experience reviewing EOB and UB-04 forms to conduct A/R activities.
• Knowledge of accounts receivable practices, medical business office procedures, coordination of benefit rules and denial overturns and third-party payer billing and reimbursement procedures and practices.
• At least two years of experience with accounts receivable software.
• Experience navigating payer sites for appeals/reconsiderations, benefits verification and online claims follow up.

Denial Specialist - North Atlanta Vein & Vascular center

(2022-12 - 2024-07)

• Ability to work well in a team environment, multitasks, triage priorities and handle conflict in a reasonable fashion.
• Problem-solving skills to research and resolve discrepancies, denials, appeals, collections.
• Knowledge of medical terminology likely to be encountered on medical claims, create and send new and corrected claim.
• Verifies coverage and eligibility as required and able to use insurance carrier portals for eligibility and claims information.
• Initiate authorization for surgery inpatient and outpatient surgery.
• Post charges, payments to correct accounts and reviews patient bills and corrects any missing or inaccurate information in a timely and efficient manner.
• Follows up on unpaid claims and clears up discrepancies by telephone, fax or email communication.
• Investigate and appeal claims that were denied, following up and completing appeals in a timely manner.
• Complete data entry to update spreadsheets and reports.

Dr. Ranjan Paul

(2022-08 - 2022-10)

• Entering the patient information for billing purpose.
• Entering new patient information into the system.
• Entering and auditing the bill with the system.
• Making calls to verify the patient insurance details.
• Entering the ICD 10 and CPT code for the claim process.
• Entering the information in patient docs, making new encounters and tele encounters.

Sr. Nurse Instructor - Mayo Institute of Medical Science - Lucknow, India

(2013-10 - 2014-06)

• Design the academic programs in the institutions in accordance with the state board regulations regarding nursing instruction.
• Mentor students build on their strengths and overcome personal or scholastic limitations.
• Provide regular feedback and advice to students and help them improve their practice.
• Conduct clinical sessions to nursing students in the classroom and work in clinical settings such as hospitals, clinics and nursing homes.
• Contribute to the development, planning and implementation of a high quality curriculum. Maintain continuing professional development.

Nurse Instructor - Birender Singh College of Nursing - Haryana, India

(2012-06 - 2013-07)

• Educate undergraduate and graduate level students in areas allocated by the Head of the Department and reviewed from time to time by the Head of the Department.
• Participate in the development, administration and evaluating exams and other assessments.
• Conduct clinical sessions to nursing students and educate them on health care needs, conditions, prioritizing, evaluating clients need.
• Perform Charge duties as needed.

Nurse Instructor - Dhanwantari Nursing College - Bangalore, India

(2011-11 - 2012-05)

• Assist in the development of learning materials, preparing schemes of work and maintaining records to monitor student progress, achievement and attendance.
• Participate in departmental and faculty seminars aimed at sharing research outcomes and building interdisciplinary collaboration within and outside the department.
• Conduct clinical sessions to nursing students and educates them on health care needs, conditions & options.
• Performed Charge duties as needed.

Circulating Nurse - Hindu Mission Hospital - Chennai, India

(2008-07 - 2009-07)

• Provide patient care before, during and after surgeries, procedures accordingly.
• Serve in the surgical team as either scrub or circulating nurses.
• Set up the surgical area, laying out instruments and supplies according to the surgeon's preferences.
• Monitor the patient's recovery over the ensuing days.
• Other duties include but not limited to assisting the anesthesiologist with a patient and conferring with the surgeon about special concerns that could affect the patient's care.

Registered Nurse - Apollo Hospital - Chennai, India

(2007-10 - 2008-04)

• Observing and recording patients' behaviour.
• Provide emotional and psychological support to the patients and their families.
• Diagnosing the disease by analyzing patient's symptoms and taking required actions for recovery.
• Maintaining reports of patients' medical histories, and monitoring changes in their condition.
• Carrying out the requisite treatments and medications.
• Taking care of post-operative patients.
• Assisting health care provider with dressing of patients.
• Providing medication as prescribed by health care provider.

B.Sc. - Nursing - M.G.R University

M.Sc. - OBG Nursing - Rajiv Gandhi University

Medical billing and coding - University of Georgia