Aruna Banjara
Hyderabad
Summary
Healthcare Business Analyst with 11+ years of experience in payer and provider organizations. Expertise in claims administration (adjudication and adjustments), provider management, healthcare billing, provider appeals and grievances, and coverage validation. Proficient in eliciting, analyzing, and documenting requirements. Adept at strategic planning, data analysis, and collaborating effectively to deliver results. Proven ability to streamline processes, implement healthcare solutions, and drive operational efficiencies using Agile Scrum methodologies.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Healthcare Consultant
Thryve Digital Health LLP
Hyderabad
06.2022 - Current
- Serve as the point of contact for client billing issues, conduct client meetings and calls to gather requirements and resolve issues, research and analyze reports to identify discrepancies, and implement solutions.
- Eliciting and documenting requirements through client interaction and analysis.
- Translating business needs into functional and technical requirements for the billing team.
- Validating, correcting, and documenting member/customer billing discrepancies, including gathering requirements for billing process improvements.
- Correcting and documenting HCR, non-HCR, and Medicare billing discrepancies.
- Resolving billing issues, analyzing system defects, and documenting requirements for improvements.
- Creating BRDs, FRDs, SRS documents, Source Logical Mapping, and Source-to-Target Mapping.
Business Analyst
Aegan Technologies
Hyderabad
08.2021 - 05.2022
- Business Analyst, Thryve Digital Health LLP (Contractor, Aegan Technologies).
Senior Analyst
MDI Networx
Pune
09.2019 - 08.2021
- Analyzed healthcare claims data, developing comparative rates, reimbursement analysis, cost analysis, and financial impact calculations.
- Performed research to identify business problems and break down the complex business issues to come up with solutions through data analysis.
- Performed activities, which are part of a bigger solution, using the ICD-9, ICD-10, CPT, and HCPCS classification systems.
- Created end-user training material and operational documentation.
- Involved in updating the team about changes in guidelines for the services due to system communications, and its coding impact.
- Led claims testing efforts, including UAT, functional, regression, and manual testing.
Process Specialist
Infosys
Pune
06.2018 - 09.2019
- Coordinated the provider grievances and appeals process, ensuring all cases were handled in accordance with company policies and regulatory guidelines.
- Conducted thorough investigations of provider complaints, gathering necessary documentation and evidence.
- Prepared detailed case summaries, and presented findings to the appeals committee.
- Maintained accurate records of all grievances and appeals, tracking outcomes, and identifying areas for improvement.
- Developed and delivered training sessions for providers on the grievances and appeals process.
Senior Practitioner
Concentrix India
Pune
12.2015 - 07.2018
- Leveraged strong analytical skills to review claim rules and workflows, ensuring accuracy and compliance.
- Adjudicated claims in accordance with Service Level Agreements (SLAs), maintaining high standards of performance and efficiency.
- Conducted audits of claims processed by team members, serving as an internal auditor to ensure quality and adherence to policies.
- Possessed a thorough understanding of standard medical coding, including CPT, ICD-10, and HCPCS.
- Identified claims with inaccurate data or those needing further review, coordinating with appropriate team members for resolution.
- Researched CMS1500 claim edits to determine appropriate benefit applications using established criteria.
Analyst
Trizetto India
Pune
09.2013 - 12.2015
- Involved in the processing and adjudication of medical and hospital claims using the QNXT application.
- Worked extensively with TriZetto applications, including QNXT, Facets, CDM, and Nimsoft tools.
- Hands-on experience with modules such as Member, Provider, Claims, Benefit, and Workflow.
- Proficient in processing UB04 and HCFA1500 inpatient/outpatient claims, as well as high-dollar claims.
- Knowledgeable in HIPAA (Health Insurance Portability and Accountability Act) compliance.
- Extensive knowledge and exposure to all hospital (inpatient, emergency, surgery, observation, outpatient, etc.) And medical contracts.
- Supported the team in processing-related queries and resolved issues according to processing guidelines.
- Specialized in working on high-dollar denial claims, ensuring accurate payment as per client guidelines.
Education
MCA (Master of Computer Applications)) -
Guru Ghasidas University (C.G)
08-2013
BCA (Bachelor of Computer Applications) -
C.S.V.T University (C.G)
06-2009
Skills
- Requirement Gathering and Analysis
- Agile Scrum Methodology
- Stakeholder Management
- Healthcare billing
- Process Improvement
- Provider appeal and grievance management
- Claim Administration
Certification
- AHM 250 - Professional, Academy of Healthcare Management (PAHM)
Timeline
Healthcare Consultant
Thryve Digital Health LLP
06.2022 - Current
Business Analyst
Aegan Technologies
08.2021 - 05.2022
Senior Analyst
MDI Networx
09.2019 - 08.2021
Process Specialist
Infosys
06.2018 - 09.2019
Senior Practitioner
Concentrix India
12.2015 - 07.2018
Analyst
Trizetto India
09.2013 - 12.2015
- AHM 250 - Professional, Academy of Healthcare Management (PAHM)
MCA (Master of Computer Applications)) -
Guru Ghasidas University (C.G)
BCA (Bachelor of Computer Applications) -
C.S.V.T University (C.G)
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