Operations Head

Magesh Kumar Sudharsan Mob: +91-988******* & 999-***-****

Email: ************@*****.*** No: 14 Selva Nagar 1st Injabakkam, Chennai, Tamil Nadu, India

SUMMARY

Profile: Male, 38, Married

Nationality: India

Current Location: Chennai

18 years of Experience in US Medical & Healthcare domain

Company: Evulate Technologies pvt Ltd, Etransmedia, FPG Health Care Pvt Ltd, Dell Perot system & Global Info Serv.

Specialties: Anaesthesia, Radiology, Cardio- pulmonary, Cardiology, Ambulatory services, Emergency Department, Internal Medicine, Family Physician etc.,

Billing Software: Medisoft, Patient Now, Mysis PM 7, E- Clinical Works (ECW), Athena, Mysis Tiger, Insync

Transition FL & NC (US) - Health Insurance Process End to End.

Passport No: R4735874

WORK EXPERIENCE

Jan 2017 –Till date Evulate Technologies, India

OPERATIONS HEAD:

About Company:

Evulate Technologies is a leading provider of revenue cycle management services to the healthcare service providers in the United States. With an indomitable spirit to succeed, Evulate Technologies made a modest start in 2014 from a small home office with a team of two. Today, with a large team, we have come a long way, and the same inspiration to achieve continues to drive us from one success to the next. Our professionals and our infrastructure to deliver the right services for improved productivity and profitability.

Responsibilities as Operations:

Managing a team of RCM delivery of charge posting, receipts posting and AR. The main objective was to ensure meeting the preset benchmarks/targets on a month on month basis. Suggesting and implementing process changes, client coordination, constantly training for freshers/teams in better efficient means to achieve goals was one of the important tasks.

Managing the medical billing system of the various clients using Industry Specific Software

Identifying process gaps and recommending possible solutions through interdepartmental contacts, resource management or policy/procedure changes

Coordinating with the project team to ensure effective delivery of project solution keeping in consideration the pre-discussed parameters

Interacting with the US Clients/Medical Professionals for regular updates on billing

Assisting the Manager in maintaining reports for Top Management

Handling Process Training for new batches and responsible for conducting weekly refresher training for the team

Promote teamwork and responsiveness of individuals in their areas of responsibility through support and coaching. Hold regularly scheduled one-on-ones with each associate to assist in associate development and career planning

As a Total Quality Analyst, instrumental in Zeroing out the # of errors reported by the Client

Monitoring both Pre & Post project transition for its smooth Off-shore operations

Maintained a strong relationship with all clients and presented trends to them on a monthly basis.

Sending Daily reports, Weekly Reports & Month end reports to the Client

Provide continuous training for team in terms of the General Billing and Client Specific weekly.

Attending weekly, monthly meetings with Operation Head & VP to discuss and address issues and queries from staff and clients.

Worked with the clearinghouse and the payers to ensure all claims were processed and received by the insurance companies in a timely manner.

Making live client calls in getting the information required in processing the claims.

Set the target for the Production Department with Time study and Quality Study.

Monitoring the Managers & Assistant Managers performance and appraise the performance at the regular intervals

Dec 2009 – Dec 2016 Etransmedia Connect 2Care (Hudson Valley Media Technologies Pvt Ltd Bangalore, India ), Troy, NY, USA

Client Relations Manager:

About Company:

Etransmedia founded on 1999 over 17 years of combined experience in the medical billing and healthcare industry. This experience includes running a billing company of over 1,000 people. After various tenures in the US Healthcare industry, they both recognized a major problem in the industry; there was a major lack of support for the medical billing and healthcare payment systems. Delivers EHR & PM, Connectivity solutions, Billing Insurance and RCM services to health systems nationwide, and serving 12,000+ providers.

The advanced functionality of Etransmedia’s complete technology enabled Billing and Revenue Cycle Management (RCM) Solutions delivers total control across patient flow, account management, claims processing and performance analysis.

Responsibilities as Operations:

Manage Medical Billing team or operations. Interact with US Clients and Management. Distribute and handle the work. Work involves calling for insurance verification and for checking claim status etc., to get the end result of getting the claims paid Flexibility in working night shifts. Improve the process by applying new methods and techniques. Reviews insurance claims to ensure accuracy as per agreement, prior to dispatch to respective insurance companies.

Process client requests, complaints and concerns on a priority basis

Calling or sending emails to the Doctors office and trouble shoot their queries.

Be a knowledge centre and help team with the billing issues

Motivate team to achieve desired Quality and Production targets

Participate in Training Coordinators meetings to identify training needs and arrange for training, re-training and cross training, as required

Handling a Demo & Charges, payments and AR team

Support and monitor day-to-day work process and meet production and Service Level Guarantee.

Participate in and contribute to client conference calls, management meetings and

department meetings

Facilitate to meet contractual obligations and client expectations

Maintain cost effective and stable workforce to absorb volume volatility

Ensure continuous training schedules based on performance and quality scores

Development and maintenance of Standard Operating Procedures and other documentation

to ensure uniformity across teams and processes

Frame policies, develop process and install procedures for facilities functions.

Consistently track and measure service quality to orchestrate people, schedules and

resources for optimum productivity efficiency and quality.

Been to United States of America for handling onshore team and successfully transitioned (Locations : New York & Philadelphia PA, Charlotte, NC)

Performance Evaluation:

Accountable for Team's Quality and Production

Communicate performance measurement parameters to the team

Measure Executives performance by using performance parameters

Periodically review team’s performance and plan to meet the needs of the client.

Various Reports Generated for In-house & as per the Clients request

Team performance report, Monthly collection report, Patient Count Report, Open charges

report. Etc… Monthly transaction reports.

Aging reports through Dates of service, Date of charge entered and claim filed date.

Charge and payment analysis report though each insurance companies

Yearly Fees schedule compare and predict the collection approximately at starting of year.

(Yearly reports). Provider reimbursement report (Yearly reports).

Updating of Providers, Insurances etc. in the Masters & Procedure analysis report.

Apr 2006 - Dec 2009 FPG Healthcare Pvt. Ltd Chennai, India

Assistant Manager

About Company:

FPG Healthcare Pvt. Ltd., is a captive unit of Family Physicians Group, Orlando, is an organization of physicians and health care professionals dedicated to have Unique focus on the healthcare sector offer services to individual physician offices, family practices, clinics, hospitals and billing companies.

Primary Responsibilities

Manage Handling health claims, Handling TPA. Monitoring end to end claims processing of TPA, Conducting Audit of TPA.

Claims Adjudication (Hospital & Medical), Claims Review examination, Quality audit and maintaining the WSR and MSR

Responsible for timely tracking and reporting of Service level performance Medical Billing

Assisting Management in recruitment process

Creating Ramp- up Plan for New Hire and up-training batches in US health insurance process and routing the client updates to the end users

Managing the team with high standards

Project transition and client interaction

Evaluating the examiners skills in various parameters

Attrition analysis and creating attrition control plan

Forecasting & Training

Achievements:

Team has consistently met all the quality parameters on a month on month basis

Awarded "Best Process" for the months of July and September 2009 in the rework queue

Created an internal auditing mechanism to strengthen the internal quality base of the team

Received appreciations from the client end for maintaining quality standards and Zero making of the claims queue.

Project details:

Carriers Handling/Handled:

Humana, Well care, Citrus, PHC & UHC

Transition – A knowledge transfer has been made on the process of Medical Medicaid, Medical Medicare, Hospital Medicaid, Hospital Medicare, EDI conversion tool testing, Appeals, Adjustments, recovery and Refunds.

Duration – 75 days.

Name of the Insurance company – Citrus

Place – Tampa, Florida, United States of America

Passport Number : G2395935

Sep 2004 - Apr 2006 Dell Perotsystems Chennai, India

Claims Examiner

About Company:

Perot Systems provided information technology services in the industries of health care, government, manufacturing, banking, insurance and others. Perot Systems was especially strong in health care industries with services such as digitizing and automating medical record. Medical billing and processes expertise with our award winning medical billing and EHR software to get you reimbursed more, faster, whether you are a solo practitioner or a provider in a large group.

Key Responsibilities:

Validating the claims according to the US Health Insurance Terms and Condition

Validating the claims for Payments and denials

Resolving pended claims using Insurance, State and federal regulations, and using Specific health plan criteria

Primary Responsibilities:

Adjudication

Client interaction

Quality Audit

Quality Audit:

Auditing of Associates production

Review and audit of High dollar claims and entering the result of the same in the audit tool

Meeting the SLA (service level agreement) for which quality check have been implemented for the claims that were paying more than $200 in professional and $2000 in Institutional.

June 2001 - Sep 2004 Global Infoserv, India

Medical Billing Executive

About Company:

Global Infoserv provider of print and related services, including business process outsourcing. Global outsourcing offering provides judgment-based professional support services and industry-focused solutions and specialize in medical billing, coding, accounts receivable management, and other healthcare related services.

Primary Responsibilities:

QC in Charge Entry

QC in Payments

Payment and AR analyzing

Insurance for reimbursement, as per their rules and regulations

TQA (Team quality Audit): Random Audits on Charge Entry & Payments (10% per person)

AR analyzing: Payments and Denial analyzing from the provider side, review and rejection concepts of claims and AR calling follow-up.

EDUCATION

Sep 2013 - Dec 2014 National Institute Of Business Management, Kerala, India

Healthcare and Hospital Management, MBA, GPA First Class

Jul 1997 - Apr 2000 Madras University Tamil Nadu, India

Mathematics, Bachelor (BSc/BA), GPA Second Class

OTHER CERTIFICATES

1998 Type Writing in Both English and Tamil Govt of

Tamil Nadu, India

LANGUAGES

Tamil Native

English Fluent

Malay Basic

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