Responsibilities:

1) Supervising the below listed process with a head count of 45 employees in healthcare operations.

--- Scheduling & Patient registration
--- Insurance Verification and Eligibility
--- Pre-authorization Management
--- Charges and Demographics Entry
--- Medical Records Department
--- Claims Management [Claims submission, front-end rejection, follow-up with payers]
--- Payment Posting and Contractual Adjustments
--- Denials, Rejections, re-submission and Appeals
--- Account Receivables Management [Including self-pay collection process]
--- Call Center Management
--- Reconciliation Services / Claims Payment Reporting’s
--- Quality Control

2) Monitoring daily productivity reports to ensure targeted goals are met.

3) Mentoring employees, conduct performance evaluations, counsel and provide corrective actions to assigned personnel, and work to facilitate individual and team development that drives positive results.

4) Maintaining contacts with various departments to obtain and analyze additional patient information to document and process billings.

5) Analyzing trends causing revenue loss and find the root cause and take appropriate action to realign staff and revise policies and procedures in order to maximize collections.

6)Keeping up to date with carrier rule changes and distributes the information within the practice.

7)Maintaining working knowledge of all health information management issues.

8)Reporting to Management on a weekly and monthly basis on process improvements.

Career Achievements:

1) Led a project to create an internal workflow management tool which can auto generate reports needed to be sent to Client that reduced the manual work.

2) Collaborated with Pega RPA and Open Span team and automated all the routine desktop tasks.

3) Explored and collected all the required details for denials resolution through various resources and developed a knowledge tool and keep it updated with the regular changes from the payers.

4) Coordinated with the Manager to stabilize two new projects and developed step by step learning aids and instruction materials.

5) Worked with large insurance companies like Medicare, Medicaid, BCBS, Cigna, Aetna, etc.,

Graduation in Physics subject