Management Quality

. To achieve success in all endeavors I undertake and establish a

successful career rendering the best of my efforts with utmost sincerity

and devotion.

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|Strategic, Analytical, Solution-oriented Professional with 7 years of |

|well-rounded experience. |

|In-depth expertise in US HealthCare. |

|Excellent communication and analytical skills. |

|Self motivated and able to work with close supervision. |

|Functioned in matrix team environment. |

|Working with Client Managers and Project Managers, understand and analyze |

|the client's requirements. |

|Documenting the client's requirements in appropriately formatted business |

|specifications. |

|Presenting the client's requirements to the team such that the requirements|

|are fully understood. |

|CMS 1500 & UB04 Claims Adjudication (Payers Domain) |

|EDI and Paper claims processing. (EDI - Transactions) |

|Knowledge of HIPAA, GLBA,ARRA,COBRA acts |

| |

Leadership Competencies:

. Self Driven and Energetic Leader

. Excellent hands- Operations, Quality & Training. on expertise in key

management functions -

. Mentoring, motivating and coaching a team of 30 people for performance.

. High degree of analytical ability and problem solving.

. Ability to lead large team size to excellence

. High degree of commitment, perseverance, determination and result-

orientation.

Quality Competencies:

. Good work experience in Medical Coding, Medical records, Overpayment

recovery, Quality Control Methods.

. Played a vital role by preparing the presentations and providing them

required data for quite a few managers to complete their SIX SIGMA GREEN

BELT projects.

. Drive & monitor process improvement projects towards increasing

efficiency, productivity and reducing timelines.

. Planning & executing new special projects within the shift/team.

. Handling pharmacy bills of customers for the drugs purchased as part of

treatment

Operations Management Skills:

. Team builder, ability to create processes.

. Overall end-to-end management capability within Team - Client interface,

Accounts mapping, Backlog Management, Team Outing, Operations and Target

achievement.

. Metric-driven approach to management.

. Execution of critical special rework projects on time, with quality.

. Effective people management skills - expertise in leading teams.

. Open to ideas.

. Identifying and taking care of the training needs; mentoring & coaching

in the team.

Personal Attributes:

. Highly organized and efficient, a flexible and versatile team player who

will work hard and excel in any environment.

. Impressive work ethic, reliable, dependable and conscious of duties and

responsibilities.

. A positive approach to all tasks and pride in achievements has resulted

in many successes.

. The ability to form good relationships with both peers and staff is

central to my character.

. Excellent organizational skills, highly efficient and capable of

completing multiple tasks.

. Ability to use resources effectively to meet work commitments.

Strengths:

. Leadership through example.

. Customer Interaction & Satisfaction; & Expectation Management.

. Strategic Manpower Planning & People Management skills.

. Strong business focus with data as its strategic asset.

. Highly process oriented with Strategic thinking and proper planning.

. Excellent communication skills.

. Quick learner and excellent team player having ability to meet tight

deadlines and work under pressure.

Worked for top-rated health insurance provider, which supports solutions

that enhance access to quality health-related services. The requirement was

to integrate and upgrade the claims processing system. The requirements

that were gathered were for Health Care claims. Insurance provider receives

claims from primary vendors for different insurance products in the form of

either batch or real-time.

. Adhering to the team's SLA requirements and a thorough understanding of

the Quality parameters.

. Handle any process related escalations issues effectively.

. Analyzing the error trends (on a daily, weekly, monthly basis from the

CAS (Claim auditing system) done by the client and preparing a work plan

to avoid the errors in the future.

. Takes care of the Quality activities.

. Conducting daily huddle meetings in the team to discuss any

communications from client, and for training or coaching requirements in

the team as part of creating a knowledge base.

. Act on client feedbacks on focus or improvement areas in the

team/process.

. Attending client weekly calls, to discuss on the week's SLA and plans.

. Identifying areas of process improvement.

. Keeping both the internal and external customer/client up to date on the

status of the assigned projects.

. Maintaining good client relationship, which involves timely

responsiveness to mails and escalations

. Maintaining TAT (Turn Around Time) in the Claim Profiles.

. Generate and sent daily and weekly reports..

Expertise in subjects such as Stop Loss, Maternity, Surgery (contracts,

reimbursements, modifiers(Bilateral, Assistant Surgeon, Co surgeon,

Bariatric surgery and concurrencies), RAPs ( Radiologists, Pathologists,Anesthesiologists) reimbursement, COB involving Medicare, Medicaid and

Commercial Primary claims, Insurance Plans and products, plan benefits,

referrals etc.

|Year |Organization | Role |

|Nov '05 to |Hinduja Global Solutions Ltd |Group Lead - |

|date | |Operations/Quality |

|Apr '04 - Sep|Kailas Marketing, Palakkad |Office Marketing Analyst |

|'05 | | |

DOB/Age August 21st, 1982 / 30 Years

Marital Status Married

Interests Books, Music, Football

Passport / Visa Details Available

Languages Known English, Hindi, Malayalam, Kannada and Tamil

Address #43/6, Third floor, 7th cross, Balaji Nagar,

Behind Lakshmi theatre,

DRC Post,

Bangalore, Pin: 560029

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CAREER OBJECTIVE:

SUbhASH. R

Team Lead - Operations/Quality

. Mobile: +91 - 988-***-****

. Email: ****************@*****.***

.

.

PERSONAL INFORMATION:

PERSONAL INFORMATION:

ACAD PROFESSIONAL ACCOMPLISHMENTS:

ABOUT ME IN BRIEF:

Application Experience & Skills

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