Resume

Name : Satish Yadav Sagarla E-Mail: ac2k2y@r.postjobfree.com

Designation : Assistant Manager Provider Services Phone: +91-703*******

Duration : Jan 11 2016 to present

Process : Provider Hospital

Associated with IKS Health

Hyderabad since January-2016

Company Profile:

IKS technology based BPO solutions to health care payers and providers. And delivers end-to-end services.

It also helps companies improve profitability, increase productivity and quality, and reduce cycle times through innovating business process solutions.

Achievement and Awards:

Certified Platinum Level Master Coach

Certified Team Manager, Apollo Health Street Pvt. Ltd

Certified Team Lead, Apollo Health Street Pvt. Ltd

Certified Subject Matter Expert, Apollo Health Street Pvt. Ltd

Honored with ‘PAT on the Back’ for the concluding quarter of the year 2011-2012.

Honored with ‘Far exceeds, Exceeds and Met’ for maintaining the best Quality and productivity on a monthly base.

Initiated YB project on one of the BCBS denials, waiting for the approval.

Initiated YB project in Online claim status report on multiple denials of Aetna.

Team Management:

Managing Team functions: planning & performance management (including performance / quality evaluation) for all team members.

Leading, mentoring, coaching, monitoring team members to ensure efficiency in project knowledge, process operations & meeting of individual & group targets.

Creating & sustaining a dynamic environment that fosters development opportunities & motivates high performance amongst Team members.

Specialized Skills/ Job Knowledge:

Specialized in Full Business Office on the Provider (Hospital/Physician) side, which includes Insurance verification, Billing, Accounts Receivable Follow-up, DMS, Quality and Transaction Postings.

Knowledge of US Healthcare claims life cycle covering commercial, government, re-pricing or managed care and the bottlenecks at each stage.

Knowledge of US HealthCare philosophy and functioning, the different types of payors, payment mechanisms and systems, types of contracts and contractual terms, kinds of plans and Revenue Generation Cycle etc.

Strong Data Analysis skills.

Based on the analysis skills automated a process of reconciling the data with the help of Implementation team

Worked in different departments like AR follow up, DMS, Cash Posting, Billing, EOB Review, CBR, PP, Charge Entry and EVBV.

Have been a part of Quality team and have done audits on Billing, AR Follow Up, DMS, EV (Eligibility Verification) for the 4 different hospitals.

COB guidelines play an important role in multiple insurance scenarios which I am very much aware of

I am well versed in understanding contracts of different payers.

Being in a Billing, AR department & DMS Follow Up, I have gained good knowledge on how the claim is generated from patient registration to claim coding then to billing team and finally to the cash posting team.

I have good knowledge on how the front-end rejections occur

I have good healthcare exposure and I know how the process works, which makes me to simplify any job which is given to me

I will look up for new ideas by thinking out of the box to simplify the work by escalating the Claims of similar nature

Always been maintaining a good track record of all the process updates which is the priority criteria for maintaining good quality scores overall till date

Highlights:

Assistant Manager Provider Hospital –Jan 2016: (Charge Entry/Billing/EVBV)

Handled a team of 75 people as per different criteria for a Project under different Sub-Projects

As a Certified Platinum Level Master Coach, coach the Team to follow the right direction and achieve the assigned Goals within the TAT

Preparing Weekly Client Reviews to Team Members as well as the management to discuss the same on internal and external calls on weekly and monthly basis to present the performance matrix to Higher Management & Client

Maintained 0% attrition rate from last 6 Months

Appraisals have been completed before the timelines

Below are the Trackers which were created to Maintain the track of each and every employee data at one place

-Production Tracker

-Quality Tracker

-Attendance Tracker

-Performance Tracker

-Escalation Tracker

-Feedback Tracker

Team Manager Provider Hospital –Sep 2015: (AR follow up)

Handling a team of 63 people as per different criteria on 30 different Hospitals

As a Certified Platinum Level Master Coach, coach the Team

Preparing MRM on monthly basis to project the team performance matrix to Higher Management

Team Lead Provider Hospital –Nov 2014 – Aug 2015: (AR follow up)

Handling a team of 55 people as per different criteria on three different projects.

Escalating the current issues on three projects to Onsite team and discussing the same with the client on a weekly call to get the resolution.

Preparing MRM on monthly basis to project the team performance matrix to Higher Management.

Providing feedback to the agents on weekly basis to ensure that they meet their assigned SLA’s.

Lead Quality – July 2014 – Dec 2014: (Quality check and AR follow up)

Managing a team of 17 people as per different criteria on three different projects.

Escalating the current issues on three projects to Onsite team and discussing the same with the client on a weekly call to get the resolution.

Preparing MRM on monthly basis to project the team performance matrix to Higher Management.

Subject Matter Expert – July 2013 – July 2014: (Quality check on Billing and AR follow up)

Identifying and assigning work to team members as per different criteria on three different projects.

Responsible of managing the entire project of 35 agents working on different payor groups

Participated in the training program and gained knowledge on Denial Management

Analyzing the individual agents work, providing feedback, and share knowledge for much effective performance

Ensuring team/individual productivity and collection targets are met/exceeded. Recommend procedural changes required to enhance productivity.

Recommend and recognize team member’s performance to the Manager & Assistance Manager.

Participate in the Quarterly performance reviews of the team members and update the Manager & Assistance Manager on the team member’s performance on a periodic basis.

Always met Team’s productivity target set by the project guidelines.

Enhancing the efficiency and effectiveness of client’s revenue generation cycle and Liquidation of Account Receivable.

Look into the needs of the team and drive the team towards higher productivity and quality levels. Also, escalate any unresolved queries or issues.

Performance recognition and recommendation for awards for team members in the team.

Interact with quality & operation team to identify and resolve bottlenecks on quality front to maximize claims resolution.

Share an excellent relationship not only with the team but also with other teams. and also approachable and share a good relationship with the other operations like Business Analysis team, QA team, IT team, Onsite staff.

Assist in the training of new team members and in integrating them into the projects in co-ordination with the Manager and/or designated trainers.

Having bi-weekly one-to-ones with all the team members to review their performances & resolving issues.

Documentation and process flow creation for training.

Senior Process Associate – January 2011 - June 2013: (AR follow, Cash Posting and Billing)

Team management, work assignment and monitoring.

Strategizing for Account Receivable from the insurances reduction for the client.

Identifying trends in payments by the various insurances like commercial, auto insurance, no fault, reprising as well as government payers and making efforts to improve them by better methods of follow-up.

Work closely with the Onsite support team and keeping them abreast about developments in billing, common errors in charge capturing, coding and mailing of the US Healthcare claims, which result in delayed payments.

Assist in Inducting of new members and integrating them into the project team.

Training individuals/team on new procedures, new systems or remedial training as and when necessary.

Constantly identifying the training needs of the project and ensure that each of the team members is certified in their assigned positions.

Attending Client meetings and updating team the same.

Worked on Multiple Projects.

Cleared the huge reserve on one of the project by managing 2 reps within 3 days.

Worked on all payer mix denials which were resulted in achieving more collection.

Cleared all online related subjects on the projects which I have exercised to verify (claim status, online reprocess, uploading Online EOB’s /EFT’s, and checking Auth/Referral status).

I am one point of contact with the team for getting online access of insurance site, which make work easier for others on the project as well as it have reduced the time taken to follow-up on each account.

Reduced the time required for an agent to update the production report on a daily basis by updating a formula in excel sheet through which it will consider the production values automatically.

I have updated a Macro through which we can get the 835 Raw files into an excel which will also map the comments for each bill and through which we can reduce manual work of the agents and the audits can also be automated for Medicare remits on all the three tasks.

Updated an online claims status report of Aetna through which we trimmed down the current payment days as we are working on conditional days.

Found a trend in sorting AR ATB which helped in removing Zero Bull, Recently worked, EOB accounts separately.

Identified several functionalities with different websites such as creating access, policy validation, use of Payspan and MR submission.

Identified better ways to validate patient insurance details for 3K accounts for $3.47 million.

Organization and Time Management:

Problem solver who quickly grasps complex situations and works them into achievable jobs.

Produce quality work under extreme time pressure and deadlines.

Proven ability to interpret and follow complex instructions to successful closings

56 months of experience successfully doing and organizing personnel time and work load.

Collaborate in teams of upwards to 40 staff to produce quality work.

Working On AR Follow Up Accounts:

Helped all the team mates how to sort the give assignment and complete the assigned work within the TAT.

I have made almost all the insurance web logins through which calling was reduced by 25% and which facilitated the squad members to achieve their aim accordingly.

Working On Rejections:

Worked on all the rejections which were received as pended from billing team and forwarded the invoice to the right direction.

And forwarded a transcript of the rejection codes and a description of the codes through which we can determine where we are amiss.

Working On Denials:

Resolved many denial issues in the project, which are as follows:

Ante partum Denials

Coding Denials

Duplicate Denials Of Health first

Physician Denials of HNJH

Psych Denials of BCBS, Americhoice, Health first

Taxonomy Denials Of HNJH

NDC Denials of HNJH

No Auth Denials of HNJH

Working On Quality

Updated with a link where we can see the exact coding denials on BCBS Massachusetts accounts as per their Medical policies.

Escalated many coding denial issues to client and out of which we had many updates and done these updates agents were able work easily on coding denials.

I have found a trend how to work on the patient follow up accounts and different ways to find the current insurance details of the patient.

Reduced calling on the accounts by updating a claim status report on a daily basis of different payers.

Currently handling a team of 5 QA (Quality Analyst).

My responsibility is to train the new QA’s about the assigned projects.

Previous Organization Details:

Organization : Inventurus Knowledge services

Designation : Process Associate

Duration : Nov 24 2009 to Dec 30 2010

Process : HMA (Health Management Organization)

Work Profile:

Denial Management.

Trained new recruits - in various profiles of work.

Improving the productivity and Quality of work in process, through various sections - consistently.

Achievements:

Was identified as best performer and additional responsibility of ‘escalations and maintaining the reports’ was given in the team.

Managed to meet deadlines and give perfect results as and when required.

Scheduled the assignments to the newly trained folks immediately after training sessions.

The Growth Path in RCM

Nov’2009 – Dec’2010 : Process Associate

Jan’2011 – Jun’2013 : Senior Revenue Cycle Analyst

Jun’2013 – Nov’2014 : S.M.E (Subject Matter Expert)

Nov’2014 – Current : Team Lead Provider Hospital

Organization: Mithra Agencies (May 2003 to Nov 2009)

Designation : Team Lead

Duration : May 2003 to Nov 2009

Process : Maruti Car Showroom Sales

Responsibilities:

Involved in devising monthly target of team.

Generating enquiries by Cold calls, devise sing new schemes and conducting events at minimum cost to company.

Responsible for maintaining 90% penetration on Allied business like In- house finance, Insurance and Accessories.

Responsible for defining and implement strategies for increasing share of new / existing products

Actively involved in business planning and assess revenue potential in business opportunities

Reporting to General Manager (Dealer Manager & Company Manager)

Managing the sales and marketing operations and accountable for top line and bottom-line growth along with corporate objectives

Responsible for gaining approvals and registrations of products with Govt. Agencies / key account bodies

Building and strengthening relationships with key accounts

Responsible for designing and implementing marketing activities such as camps, road shows and mega events for enhancing brand awareness and visibility resulting in increasing sales

Enabling business growth by developing and managing a network of dealers partners

Achievements:

Responsible for selling 150 cars per month along with the team members

Personal Details:

Name : Satish Yadav S

Father’s Name : S L Babu

Date of birth : 11th March 1983

Gender : Male

Marital status : Married

Nationality : Indian

Languages known : English, Hindi and Telugu

Contact this candidate