Experience

CGM ARIA Health Services (India)

• India
• Hospitals and Health Care
• 100 - 200 Employee

• Quality Assurance Specialist

  • Nov 2022 - Present

  • Prepare list of deviations for correction and verify corrections as per established company standards • Identify areas requiring training and ensure gaps are filled. • Reporting daily/Weekly/Monthly Audit reports Coaching and feedback to individual and Team. • Responsible for process improvement & inventory trend. • Design implement and improve company quality standard. • Develop strategies to improve the production process. • Create report to track the process. • Maintain audit productivity and RCA reports for entire team. • Provide training to new staff for product knowledge. • Attending internal and external call calibration sessions as required. • Generate the QA reports and communicate the same to the stakeholder.



FinThrive

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Senior Analyst

  • Sep 2017 - Oct 2022

  Associated with US Healthcare organisation and working in Revenue Cycle Management. • Responsible for administering accounts receivable; processing, verifying and recording financial documents and forms; insurance claims and forms; and collecting user fees and payments on overdue accounts • Implement efficient working processes and co-ordinate, assign and review the work of team members • Act as a technical specialist on certain types of accounts receivable transactions and provide guidance and assistance to Billing Team • Identify root causes, recommend and implement solutions for collection process improvement • Ensure all accounts in the analyst queues are worked daily and review /identify bad debt and set reserve on a monthly basis • Reconcile hospital accounts and propose credit memos as required



ACCRETIVE HEALTH SERVICES PRIVATE LIMITED

• India
• 1 - 100 Employee

• Senior Analyst

  • Aug 2015 - Apr 2016

  • Examine and verify accuracy of work and authorize routine payments, credits and other transactions. • Identify training needs and train workers in job duties and company policies. • Resolve work-related problems and prepare and submit progress and other reports • Responsible for refresher training (RCM + DENIALS) projected. • Responsible for the Insurance balances in hospital system for claim. • Responsible for make call to Insurance company for the reason/status of denied/rejected claim. • Responsible for Cross verification for the benefits coverage information from patient through mail conversation due to high dollar value billed claim.



UnitedHealth Group

• Hospitals and Health Care
• 700 & Above Employee

• Claim Associate

  • Jan 2013 - Jul 2015

  • Resolve work-related problems and prepare and submit progress and other reports. • May perform the same duties as workers supervised . • Escalating the queries or system issues to Client through IM and Mail Conversation. • Review the medical records and send the payment processing instruction to appropriate department. • Verify the fraud claim (if providers have done any kind of fraud). • Resolve work-related problems and prepare and submit progress and other reports. • May perform the same duties as workers supervised . • Escalating the queries or system issues to Client through IM and Mail Conversation. • Review the medical records and send the payment processing instruction to appropriate department. • Verify the fraud claim (if providers have done any kind of fraud).



Mercer

• United States
• Professional Services
• 700 & Above Employee

• Senior Analyst

  • Oct 2011 - Dec 2012

  • Responsible for Customer Pension calculation as per Scheme and tenure. • Responsible for New account generation and maintenance as per customer requirement. • Responsible for the Cash Flow CIPs as per the scheme’s liabilities with 24 hrs TAT. • Responsible for Customer Pension calculation as per Scheme and tenure. • Responsible for New account generation and maintenance as per customer requirement. • Responsible for the Cash Flow CIPs as per the scheme’s liabilities with 24 hrs TAT.



EXL Health

• Hospitals and Health Care
• 700 & Above Employee

• Claims Specialist

  • May 2010 - Oct 2011

  • Handled Customer Queries, Request and Complaints. • Service Provisioning and De-provisioning as per requirement of the Customer. • Maintain the WIP data of team on daily basis and reported to A.M & Operation Owner • Handled Customer Queries, Request and Complaints. • Service Provisioning and De-provisioning as per requirement of the Customer. • Maintain the WIP data of team on daily basis and reported to A.M & Operation Owner