UMA MAHESWARI K

Bahrain, Manama, Contact: +******75 (M)

CPR: 800103491 E-Mail: ac8k2j@r.postjobfree.com

PROFESSIONAL SUMMARY

Highly motivated and committed Senior Process Executive with 9+ Years of Experience in HEALTH INSURANCE in Healthcare Medical billing.

Sound knowledge in Reimbursement, Approvals, Pre-Authorization, Resubmission, Claims Processing, Patient Demographic, Charge Entry & HCFA UB92, Online Status Inquiry & Claim Settlement.

Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.

Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.

Present cases and participate in their discussion at claim committee meetings.

Possess good communication and interpersonal skills, agreeable personality, positive attitude and perseverance to undertake challenging jobs.

Committed, result oriented, innovative, hardworking person with quest and zeal to learn new technologies.

PROFESSIONAL EXPERIENCE

Working as a Reimbursement cash claim officer in CIGNA-SAICO Health Insurance Co in Bahrain

Worked as a Medical Claims Processing Executive in GULF ELECTRONIC MANAGEMENT SYSTEMS (GEMS), Bahrain.

Worked as a Billing Associate in Lister Technologies Pvt Ltd, Chennai.

Worked as a Sr. Process Executive in COGNIZANT TECHNOLOGY SOLUTIONS PVT LTD, CHENNAI

Worked as a Payor Relationship Executive in E4E NITTANY Solutions Private Limited, Chennai .

Worked as a Insurance Claims Test Analyst in AmitySoft Technologies Private limited, Chennai.

Worked as a Senior Data Conversion specialist in Infocache Technologies Pvt Ltd, Chennai

Designation : Reimbursement Claims Processor (Cash Claims)

Duration : AUG 2015 to Till Date

Roles and Responsibilities:

To identify Claim issues, correction, currency converting outside area of coverage claims, code and/or pend due to missing information

Apply in depth knowledge of coding principles to validate missing or incomplete CPT, HCPCS, ICD-10 codes

Balances and posts cash day received, including wire transfers, e-checks, and credit cards, in accordance with established policies and procedures. Ensures appropriate reimbursement.

Researches any cash application problems, and takes corrective action.

Interacts with supervisors and co-workers in assuring data is accurate and submitted in accordance with processing deadlines.

Identifies cash remittances by system categories and contacts branches or organizations when needed to determine application.

Gulf Electronic & Management Systems (GEMS), BAHRAIN, HIDD

Gulf Electronic & Management Systems (GEMS), BAHRAIN, HIDD

Designation : Claims Processing Executive

Duration : June 2013 to JULY 2015

Roles and Responsibilities:

Medical claim adjudicator & Sound knowledge of Medical terminology –ICD-10

Quality check of the Processed claims by the Team members and report the same to the Quality Manager.

Providing Out & in Hospital settlement and services to Gulf Union Insurance as per CCHI.

Auditing the claims processed by team members, provide claims training & floor support to Team Members & to prepare reports for Production and submit to higher management.

Maintain the MIS of the Team members and update all the policy guidelines from time to time to the entire team.

Co-ordinate with client & pre-authorization dept regarding the queries of the claims and find the solution for the same.

Constantly striving to manage Turn Around time (TAT) of the process.

Consistent Performance in achieving the target above the desired level.

Settlement of Re-Submission & Re-imbursement claim for Major Providers.

Adjudicate high dollar medical claims - In House claims, Reimbursement & Capitation claims.

KEY ACHIEVEMENTS:

As a Customer Support Executive, was nominated for four times for Best performance award and Won Two Best Performance Award for month of June and July for Outstanding Performance in Production and Quality.

Internally, promoted as Acting Supervisor for Customer Support Executives in the month of April 2007 in E4E Nittany Outsourcing Ltd.

Currently as Project In-Charge for a pilot Short-Term Outbound Project in Health Insurance Enrollment. (U.S.)

EDUCATIONAL QUALIFICATION

MBA in HR from Madurai Kamarajar University during the period of 2006-2009.

Bachelor of Science in Psychology from Chennai University during the period of 2001-2004 (74.38 %).

CPC (Professional Medical Coder-ICD 10 CM)

Diploma in Desktop Publishing from TATTI (Tamilnadu Advanced Technical Training Institute) in 1998.

Diploma in Computer Application (DCA) from TATTI (Tamilnadu Advanced Technical Training Institute) in 1999.

TECHNICAL skills

Operating Systems : Windows 9x, 2000, Xp, Ms office, ERP

RDBMS : MY SQL Server.

Automated Tools : Win Runner 8.2, QTP 9.2 Manual Testing, ERP.

Personal Details

Nationality : Indian

Marital Status : Married

Father’s Name : V.S.Kittu

Languages Known : English, Tamil, Malyalam

Date: Yours truly,

Place: UMAMAHESWARI KITTU

CIGNA SAICO HEALTH INSURANCE COMPANY BAHRAIN

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