Kavitha B

Phone: 998******* Email: adycgf@r.postjobfree.com Place: Bangalore 560091

SUMMARY

Overall 4+ years of practical, hands-on experience in US Healthcare insurance industry in Claims processing, Denial management and Group Insurance Enrollment. Experienced in Revenue cycle management process & training. Highly organized, neat and focused on accomplishing assigned tasks efficiently. Following business code of conduct and acting with integrity. PROFESSIONAL EXPERIENCE

Recent Experience:

Parent company: Innominds Software Pvt Ltd (From Sep 2022 to June 2023) project name- WorkIt claims (Denial management)

Role: Senior consultant /BA

• Line of business (Claims, Eligibility and benefits) objectively reviewing and Interpreting standards, procedural documentation.

• Responsible for ensuring claims are processed accurately and timely.

• Analyzing denial RARC and CARC codes on denied claim and following up with payer calls on Denial, understanding payer claim denials.

• Working with Telehealth denials and Medicare, Medicaid claims.

• Understanding ICD and CPT codes, using CMS-1500 form for claims processing.

• Calling / Following up with insurance companies on behalf of provider/physician to resolve claims Denial and ensure timely payment.

• Prioritizing pending claims for calling from aging bucket and convince insurance companies

(payers) for payment on outstanding claims.

• Reviewing provider claims which are not paid by insurance companies and making necessary corrections and resubmitting for payment.

• Posting payment through cash /cheque/online transactions and writing off the contractual adjustments accordingly while working on claims.

• Meeting daily/weekly/ Monthly targets set by the Team leader with set quality metrics.

• Conducted KT session on process training up to near 20 team members for project requirement.

• Performing internal audit for over 100% audit on processed claims and providing feedback on same for quality improvement.

• Providing Buddy support for team members by assisting with queries on process.

• Working with departmental managers to outline the specific data needs for business method analysis projects.

• Analyzing business processes and Auditing/ identifying improvement opportunities for business growth.

• Monitoring project timeline and following up with various team members for ensuring timely completion and delivery of projects.

Application used: Waystar, Avality, OneSource and other payer portals such has UHC, priority Health, Cigna and CMS etc.

Previous experience:

HGS HealthCare - Bengaluru, India (From Aug 2018 to June 2022) Client: Blue Shield of California (Claims processing and Enrolment ) Role: Senior process Consultant

• Responsible for group insurance Enrolment by Enrolling subscriber/ Member into group and initiating eligibility plans such has HMO, PPO, vision and dental per request on Waiting period and assigning primary care physician per request.

• Initiating enrollment and sending out welcome letters with ID card upon Qualifying events.

• Proficiency in HIPAA, COBRA and able to process/ Enter sensitive PHI and confidential financial information.

• Used with both professional CMS-1500 for physician claims and for hospital claims used UB04 forms for claims processing.

• worked along with private /commercial payers, Medicare and Medicaid claims.

• Doing complete research on patients accounts for benefits verification and eligibility.

• Verifying Coordination of benefits and updating if required & Allocating authorization for particular procedures codes.

• Allocating the assignments to the team members by pulling data from Dashboard and ensuring of assignments completion.

• Used data to create models that help team performance meeting required quality like SLA and TAT.

• Responsible for Auditing/ identifying improvement opportunities for business growth.

• Handled up to 7 team members by mentoring each and providing refresher training for performance improvement.

• Responsible for scheduling team meetings and discussing about Team Daily production and quality review.

• Identifying improvement areas using Error Trend and providing feedback. Application Used: Salesforce, shieldlink, Citrix, Facets, PIMS and EDI etc. Achievements

• Successfully given Presentation to client regarding Monthly performance and quality.

• Received Monthly Top gun for top performance & Spot Award for New project documentation.

• providing guidance, coaching and training to other employees within job area.

• Recognized has process trainer for three project and trained new recruits by complying with the company regulations & Compliance.

CORE COMPETENCIES

● Microsoft office tools such has excel, Word and PowerPoint.

● Good Communication skills (Both written and verbal)

● Project management skills

● Leadership skills

● Analytical skills

● Presentation skills

● Interpersonal skills

● Self-learning

● Decision making

● Planning and Organizing skills

● Critical thinking

Technical skills: SQL, data validation, conditional formatting, pivot table, VLOOKUP, HLOOKUP and basic lean six sigma tools.

Educational details

Om Sai Degree College, Bengaluru— Bachelor's Degree April 2015 – June 2018 Finance & Accounting, Cost accounting, Business tax, corporate tax, Income Tax

SJRC Women’s college, Bengaluru— II PUC

April 2013- March 2015

Computer Science & Accounting, Business studies

Vidhyashree High school, Bengaluru - Primary education April -2013 mathematics & biology

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