Ramalakshmi Tammineni

803-***-****

US Citizen

ad34w0@r.postjobfree.com

Professional Summary

Healthcare claims processor, well versed in health insurance statutes, regulations and practices. Expertise in quickly analyzing documents and data to determine eligibility and courses of action. Analytical and motivated with strong results focus and attention to detail. Proficient with various claims processing software packages with excellent data entry skills. Effective communication skills with medical groups, insurance companies, and customers that serve to lessen confusion surrounding the processing and status of the claim. Adept at multi-tasking and completing assignments within any and all deadlines.

Job Objective to obtain a Data Entry Operator position that fully utilizes my experience and abilities.

Highlights

•Provider Enrollment Specialist with data maintenance and management

•Remarkable experience in data entry (alpha and numeric)

•Command of medical insurance claims laws

•Medical terminology

•Customer Service, Auditing, Training, Analysis and Operations

•Proficient with claim processing software

•Organized

•Self-motivated

•Time management

Professional Experience:

Project: NTT DATA

Title: Provider Enrollment Specialist

Sept Oct 2021 to Present

Provider Data Management (PDM) easy -to-use way for providers to update, validate, and attest to the accuracy of their information, and given that the right data is an integral part of delivering care to members and support to healthcare providers the team synchronizes data on multiple claims systems. In addition, it implements the business rules applicable to each database. It ensures adherence to business and system requirements of payers’ customers pertaining to contracting, network management, and credentialing the team updating provider records to yield seamless reimbursement processes and streamlining inter-region and cross-market guidelines for demographic updates.

Responsibilities:

As a PDM team member is responsible for the accurate and timely maintenance of provider information on all Federal (NPPES,STATE FILE,VISUAL CACTUS,FACETS,MS ACESS EXP TOOL,MICROSOFT OFFICE, OUTLOOK,EXCEL,WORD)and State databases, Medical Boards or Network for payer to ensure smooth and efficient transactions upon completion of the Contractor’s Quality Assurance Process, the Contractor shall grade or satisfy each Primary Source Verification(PSV).

Maintain accurate databases and reports to monitor network compliance with State requirements.

Avoid creating duplicate provider records in Facets and the practitioner record is critical for encounters and claims payment.

We load practitioner record to the Provider Group ID will be added to the record to link the practitioner to the Group.

We load the practitioner record is linked to both a Common Practitioner and Group record in Facets and practitioner cannot exist in Facets without a Common Practitioner record.

We load Common Practitioner record must be created prior to creating the Practitioner record and practitioner can have multiple practitioner records that point to one Common Practitioner record and practitioner is a non-facility-based provider and Facets Practitioner Application contains demographic, payment, group and tax information about the provider and The Facility Application is used for medical entities, such as a Hospital, Laboratory, Ambulatory Service Center and The Facility record is critical for encounters and claims payment.

DME (Durable Medical Equipment) and Ambulance companies.

Review and audit provider set ups within business systems to ensure compliance.

Maintain and updated provider data applications and coordinate the data verification process for providers enrolled in networks.

Manage and resolve complex provider data issues, such as mass change updates, limited reconciliations, and direct submissions of urgent, requests.

Coordinate provider data between the health plan database and various oversee the provider termination process including adding and changing new or existing provider records.

Analyzing and processing provider transactions in accordance with plan provisions.

Should follow the policy and procedure which is defined by the customer.

Secure the PHI information and established working knowledge and application of specialized technical skills.

Demonstrates knowledge of internal operations and develops relationships to facilitate workflows.

Strong understanding of current processes and procedures and may identify opportunities for improvement.

Projects and assignments are typically non-routine and variable.

Resolves more complex situations by applying demonstrated knowledge and skills generally acquired through job experience.

Experience in Healthcare processing whe3re I had to apply business rules to varying fact situations and make appropriate decisions.

Experience in Provider data management and/ or Provider credentialing

Experience in Visual Cactus and Facets, MS Access EXP, Outlook.

Experience with the Microsoft Office suite that required daily usage of Outlook, Excel, and Word.

Environment: Visual Cactus and Facets, MS Access EXP, Outlook.

Pinnacle Consulting LLC

Data Entry Operator

May 2020 to Aug 2021

Project was to SCAN and digitize data from all gas service cards. Design ways to capture gas facilities on an ongoing basis while doing service installs, replaces, retires and relocates. Integrate viewing of service cards from GIS, CIS and Field Services. Currently engaged in capturing services infrastructure directly in GIS from field mobile applications.

•Accurately input data into a variety of computer programs.

•Utilizing both written and verbal communication skills, provided a high level of Customer Service & Client Relations.

•Answer phones and create notifications in the computer system.

•Constant contact with internal staff and external customers.

•Demonstrating flexibility and ability to learn quickly.

PWC Columbia, SC

Claims Processor & Data entry

Nov 2019 to April 2020

•Process refunds/reinstatements/ rejections of insurance claims, running reports on a weekly and monthly basis.

•Reviewed patient accounts and resolved them to a zero balance by researching and investigating all outcomes.

•Kept track of the inventory by reporting and sending weekly updates planned, prioritized, organized and completed work to meet established production goals or quotas.

•Resolved customers issues in regards to the settlement of claims not limited to arranging rentals, and payment for damage.

•Research disputed claims on caller’s behalf to assist in liability decision.

•Remarkable experience in data entry (alpha and numeric)

•Proficient in Microsoft Office products (Word Excel Access and Outlook), 10-key and Alphanumeric typing.

•In-depth knowledge of entering data fields into computers in Windows processes typing Speed 15 to 20 words per minute

•Remarkable skill in coding information into proper form for entry

•Excellent data entry skills

•Strong clerical and administrative skills

•Ability to process high volume of data on-line accurately.

Client : MMIS Replacement for State of South Carolina

Duration: May 2018 – Oct 2019

Title : Healthcare Consultant - Quality Assurance Advance

Project#1: SCDHHS Medicaid Enterprise System,

The Replacement Medicaid Management Information System (RMMIS) project for the state of South Carolina Department of Health and Human Services (SCDHHS) is replacing the existing mainframe MMIS system. SCDHHS is restructuring its organization and business operations in order to improve the MITA maturity level using MITA3.0 framework and become a more outcomes-driven enterprise for the State’s Medicaid program. The SCDHHS Medicaid Enterprise System (MES) utilizes the MITA3.0 framework and establishes standards and regulation procedures with the SCDHHS data governance to meet the CMS guide lines.

Project #2: SCDHHS Medicaid Manhattan Project (SMMP)

The SCDHHS Medicaid Manhattan Project (SMMP) changes are mainly focused on capturing the Baby Net member enrollment, maintenance information, and the electronic data interchange (EDI) between MMIS and BRIDGES. The changes to Curam were implemented to capture Medicaid and Non-Medicaid (PCAT 89) eligibility for BabyNet members.

The SMMP established the content management mechanism to manage paperwork generated through the referral process and updated on Curam to enroll BabyNet members. Then the Baby Net enrollment and maintenance data is sent to the MMIS through a nightly batch process. The BabyNet eligible members’ enrollment data is sent from MMIS to BRIDGES using MES in the form of the HIPAA 834 transaction set and receives the X12 TA1 acknowledgement from BRIDGES.

QA Responsibilities

Analyze business requirements for BabyNet members’ enrollment data extraction of HIPAA 834

Wrote, execute test cases, and attach the evidence details in JIRA for System Testing and User Accepting Testing (UAT) for testing BabyNet members’ enrollment data from MMIS to Data Lake then apply data cleansing rules then updated in Operational Data Store(ODS) for daily and monthly audit files.

Compare MMIS members’ enrollment data and HIPAA 834 data segments record by record and notify the development team if there are any errors.

Analyze test results, track the defects, and generate reports using JIRA.

Involve in Agile testing methodology and participate in daily status meetings.

Prepare Test Summary Closure Report in QA and UAT environment and send to test team.

Organized and facilitated project planning, daily stand-ups, sprint reviews, retrospectives, sprint/release planning, demos and other Scrum-related meetings

Experience working in agile environment with emphasis on Product Backlog creation, User Story Creation, Story Point Estimation and prioritization.

Environment: Java, Apache NiFi, Mark Logic, Oracle SOA, Oracle MFT, Web Logic, Tomcat, Agile and Scrum, Jenkins, GitHub, Git, Maven, JIRA, X-Ray, REST API, J Record, Oracle EDI Document Editor, EDI 834, Confluence, Windows, Linux.

Client: The State of Arkansas Member Eligibility System, Little Rock, AK

Education:

GED at Rosen Wald Community Learning Center

Lexington, SC

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