SWETHA KODUKULA

Phoenix, AZ *****

+1-470-***-****

ady5xi@r.postjobfree.com

Professional Summary:

•Having experience in analytical and knowledgeable enrollment specialist with knowledge of credentialing, enrolment and claims.

•Has experience in the healthcare industry.

•Has experience in health care claim processing.

•Oversaw processing and preparation of new member enrolment.

•Experience on manual testing and coordinated with other teams to resolve the defects.

•Worked on different Queues in enrolment.

•Worked on Softheon and UMV.

•Monitored all enrolments to identify any processing problems.

•Worked on ticketing system for the data entry.

•Worked on Updating, Verifying & Issuing tickets through email.

•Has experience on responding to customer calls, ticket confirmation and resolving customer queries.

•Worked with different types of data like numerical and alphabetical.

•Proven ability to quickly learn new things and willingness to learn new technologies.

•Has experience in reviewing the file before distributing to other teams.

•Worked on performing the Quality Control on documents as they are received from the Customer.

•Have good communication, interpersonal, and coordination skills.

•Always flexible in working for the team willing to learn new things.

Technical Skills:

Application -MS OFFICE (MS Word, Excel, Power point, Outlook), SAS, QuickBooks. Operating System - Linux, UNIX, Windows 98/2000/XP/10/11.

Browsers - Internet Explorer, Mozilla Firefox, Google Chrome.

Education:

Masters In Business Administration

Professional Experience:

Cognizant LLC, Phoenix, Arizona April 2018 –Dec 2018

Enrollment Specialist March 2017 –Nov 2017

•Processed enrolment file errors, ID card generation errors, PCP assignments.

•Performed enrolment functions like adding new members, worked on claims, and encounter requests for verification and updates, PCP assignment activity and enrolment/disenrollment activity.

•Made external phone calls with other health insurances to determine primary payer details.

•Had experience with claims processing.

•Oversaw processing and preparation of new member enrolment.

•Manual changes are made to the Insurance Members for active, inactive, suspended, awaiting payment cases.

•Assist in the resolution of outstanding payments from past due accounts.

•Evaluated the Bad Debt Cases and updated it to the related member files.

•Identified Nonpayment of Initial Member Enrolment and updated it to the related member files.

•Cancellation of a passive enrolment if previous coverage was Termed or Canceled with voluntary withdrawal.

•Worked on member information reconciliation procedures.

•Worked on different Queues in Enrolment and different tools like Recon and UMV.

•Monitored all Enrolments to identify any processing problems. .

•Has experience in reviewing the file before distributing to other teams.

Environment: Windows 10/11, MS word, Excel, Power point, Data entry, Softheon, Citrix, UMV (Unified Member View), PRIME tool, OMNI tool.

Contact this candidate