AKILA J E-Mail : adofag@r.postjobfree.com

No.**/*, Ravi Illam, 1st street, Mob : 740-***-****

Subramaniyampalayam, Passport # : J 0473243

G. N. Mills post, US VISA : B1 Visa (10Years Validity)

Coimbatore – 641 029

Career Objective

To use my potential for the organization’s growth that adds up to develop my career growth and skills. I possess the ability to mould myself to the new innovating the skills.

Career Highlights

Total working experience of 9 Years in the field of BPO also 3 Years in Import & Export Documentation

Currently working with NTT Data Information Processing Services Pvt Ltd

Strength

Sound knowledge in US Insurance & Import & Export Documentation

Well experienced in MS Office

Enjoy contributing to team effort and able to work with minimal supervision

Punctual

Achievements

I Received Customer Appreciation Awards “BRAVO Diamond Award” in 2017

Completed the certificate course for SIX SIGMA GREEN BELT in 2016

Got DELL CHAMPIONSHIP award April 2014 to April 2015.

Two times got DELL ON THE SPOT award Feb 2015 to Aug 2016

Have travelled to Onsite for the transaction purpose for one month to United States of America and have trained the team in various parts of process

NTT Data Information Processing Services Pvt Ltd

(Feb 10th 2014 – Till Now as Health Care & Insurance Operation Associate & SME)

Work Experience:

Provider Enrolment end to end (Demographics, Credentialing and Contractual Maintenance).

Provider Contracting analysis were we providing a contract to the provider under group or to individual provider.

Concept of RCM – Working on Physician Billing end to end resolution of claim for the Payment with the time frame.

AR Analyst, Knowledge on Denial Management in Professional Claims checking to the insurance website for claim payment or denial status to make the necessary corrections in the claim form to get the correct payment to the provider.

If claim paid correctly, we would proceed with the follow up with posting the payment.

Worked as Medical Claim Adjudicator where we check medical procedure codes and diagnosis code analysing together and taking a decision for payment or denial.

We will Receive EOB (Explanation of Benefit). If Paid EOB, we will move that claim to payment posting team to post payment in Provider Account.

If Denied EOB, we will be working on that denial and take appropriate Actions.

AR Quality Analyst – Auditing accounts and providing feedback to the users to improve the Quality.

Roles and Responsibilities – Subject Mater Expert – Mar 2018 to till now

Responsible for working the denied claims & attended client calls on regular basis to streamline the process & workflows.

Reviewing the denied claims and need to get and give the payments as much as possible.

Coordinate with clients which will also help us to make payment.

Resolving pending claims and calling the insurance if necessary, to resolve the issues

Maintaining attendance, production, quality, login time and active hours reports and sharing the same to Management in daily and monthly bases.

Roles and Responsibilities – Subject Mater Expert – Apr 2016 to Feb 2018

Resolving the process quires and quality rebuttals to External Audit for the team.

Maintaining the process Dashboards, daily Monitoring Trackers for the team.

Attend clients calls and communicate updates to the team members.

Motivating team to achieve desired Quality and Production targets.

Allocating work to the team as per priority.

Maintained attendance, production, quality reports and sharing the same to Management in daily and monthly bases

Roles and Responsibilities – Process Associate – Apr 15 to Mar 2016

Analyse the provider data, credential and provide contract to the provider under group or individual provider

Responsible to achieve 50% target with 100% accuracy also did audit for internal team members to maintain team quality.

As per priority allocating work to the team.

Trained and provide floor support to the new hires.

Roles and Responsibilities – Process Associate – Feb 14 to Apr 2015

Problem solving skills to research and resolve discrepancies, denial, appeals for claim payment.

Worked with major Health Care Organizations in claim adjudication

Responsible to achieve daily target with 100% accuracy.

The Supreme Industries Ltd (Mumbai)

(From Sep- 2010 to Oct-2013: As a Import Executive)

(Supreme Industries Ltd is a company engaged in manufacturing of various plastic products)

Submission of relevant documents like bill of entry, packing list, Invoice etc. received from overseas supplier to Custom House Agent after verifying price.

Scrutinizing the checklist received from Custom House Agent for clearing the shipment

Follow up with Custom House Agent with letters and telephone calls for clearance of the shipment

Submission of documents like Letter of Credit to bank for the payment with regards to import of raw material

Perot systems Business Process Solutions India Pvt. Ltd:

(From 5-Feb-2007 to 7-May-2009: As Senior Executive – Claims Entry /Quality Analyst)

Roles and Responsibilities – Process Associate – Apr 2008 to May 2009

Attending Quality related meeting & organizational training programs

Maintaining all the quality related tasks like clarification tracker, rebuttal tracker Quality trends

Feedback analysis and actions (External & Internal level).

Internal & External Quality adherence.

Team handling if required.

Roles and Responsibilities – Process Associate – Feb 2007 to Apr 2008

Analyse the claims on source of benefit to identity the Paid/Denied/Overpayment/Underpayment/Non covered service.

Validate the claims and process accordingly.

Update the paper claim information in database (CMS 1500 & UB 04)

Attend the weekly client calls and clarify the doubts.

Timely finishing of all allotted assignments without compromising the quality

Workshops attended

Interpersonal Skills

Conference Call Essentials

Time Management

Conflict Management

Presentation Skills

Business Etiquettes

Email ethics

Listen: Loud & Clear

Teamwork

BPO creativity and problem solving

E-mail Writing Skills

Academic Credentials

2006 Bachelors of Commerce with Computer Application

2003 H.S.C. from Ranganathapuram Girls Higher Secondary School

2001 S.S.C. from Ranganathapuram Girls Higher Secondary School

Personal Details

Date of Birth : 30/01/1985

Sex : Female

Nationality : Indian

Marital status : Married

Language Known : English, Hindi, Tamil, and Malayalam

Passport Number : J 0473243

VISA : 10 Years USA B1

References : Available on request

Declaration:

I hereby declare that the above information and explanations are true and correct in the Best of my knowledge.

Place:

Date: (Akila J)

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