ASISH VALATH
Thrissur
Summary
I am a creative, dependable, and energetic professional with a strong passion for innovation in healthcare. With a background in medical adjudication, I excel in verifying the medical admissibility of claims, interpreting ICD coding, and ensuring compliance with insurance policy terms and conditions. My quick learning ability and research-oriented mindset enable me to thrive in competitive environments, where I handle pressure sensibly while maintaining high performance standards. I possess excellent communication skills, including fluency in multiple languages, which I leverage to coordinate effectively with internal teams and external providers. In my recent role, I specialized in scrutinizing claims, evaluating co-pay specifics, and managing documentation to facilitate efficient claim processing within stipulated timelines. My objective is to leverage my skills in patient care and claims processing to contribute to strategy development, promote innovation in healthcare delivery, and foster a collaborative work environment that supports growth and success.
Overview
3
3
years of professional experience
1
1
Certification
Work History
Senior Executive
Medi Assist TPA
Bangalore
07.2023 - Current
- Verified the medical admissibility of claims by meticulously confirming diagnosis and treatment details.
- Scrutinized claims in accordance with the terms and conditions outlined in insurance policies.
- Interpreted ICD coding, evaluated co-pay specifics, classified non-medical expenses, and assessed room tariffs and capping details.
- Distinguished between open billing and packaged services to ensure accurate claim processing.
- Managed the distinction between PA (Pre-Authorization) and RI (Reimbursement Invoice) claims, adhering to respective processes and verifying essential details.
- Ensured completeness of required documentation for claims processing; raised Insufficiency Reports (IRs) for missing documents as necessary.
- Collaborated with the LCM team for handling high-billing cases and coordinated with provider teams to resolve tariff availability issues.
- Made decisions to approve or deny claims based on policy terms and conditions, ensuring compliance with Turnaround Time (TAT) benchmarks.
- Handled escalations and responded to correspondence promptly and professionally.
Clinical Pharmacist
Relex Health Care Services Pvt. Ltd.
Bangalore
10.2021 - 06.2023
- Collaborated closely with in-house physician to develop and execute individualized care plans
- Monitored patients' progress, provided education and support, and facilitated necessary interventions to ensure optimal treatment compliance and overall well-being
- Implemented home-visit program targeting patients requiring chronic care, focusing on optimizing medication and lifestyle adherence to enhance health outcomes
- Responsible for patient education on medication side effects and providing empathetic counseling during home visits for chronic care
- Utilized effective communication to address concerns, provide comprehensive information, and promote understanding
- Collaborated with the physician to customize counseling strategies
- Demonstrated exceptional empathy, rapport-building, and patient engagement skills
Education
Doctor of Pharmacy -
Rajiv Gandhi University of Health Sciences
Raichur, Karnataka01.2021
Intermediate (XII) -
GHSS Mullassery (HSE)
Mullassery, Kerala01.2015
Skills
- Policy Adherence
- Attention to Detail
- Analytical Thinking
- Medical adjudication
- Excel Spreadsheet Management
- Employee Training
Certification
- Certified for internship of 1 year at Navodaya Medical College Hospital & Research Centre, Raichur. (2020 - 2021)
- Attended KAAPTICON -3 Annual convention of association of pharmaceutical Teachers of India organized by N E T Pharmacy college, raichur
- Attended National seminar on DRUG DISCOVERY AND DEVELOPMENT held at NET Pharmacy college, Raichur
- SQL ESSENTIAL TRAINING (05/2023 - 06/2023)
Languages
- Malayalam
- English
- Hindi
- Tamil
- Kannada
Projects
- Assessment Of Appropriateness In Glucocorticoid Prescribing In A Tertiary Care Teaching Hospital (07/2019, 08/2020)
Research was conducted at our hospital to produce reliable data for the evaluation of drug use in various pathological conditions to assess the appropriateness of glucocorticoids. The research examined whether the drug is prescribed appropriately with respect to dose, duration of therapy, and ROA for early detection of glucocorticoid-related issues and minimizing complications.
- Pharmacovigilance Awareness among Community Pharmacist (11/2020, 03/2021)
An investigation was carried out in our area to assess the information on community chemists' knowledge of pharmaceutically relevant activities.
Timeline
Senior Executive
Medi Assist TPA
07.2023 - Current
Clinical Pharmacist
Relex Health Care Services Pvt. Ltd.
10.2021 - 06.2023
Doctor of Pharmacy -
Rajiv Gandhi University of Health Sciences
Intermediate (XII) -
GHSS Mullassery (HSE)
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