Summary
Overview
Work History
Education
Skills
Accomplishments
Awards
References
Timeline
Generic

BAIJU THAMBY

Bangalore

Summary

In charge of supervising Medical Claim Billing's Global Payment Operations and Quality/Training efforts. Skilled customer relations specialist with over 23 years of experience in funds, financial services, and customer care management in a variety of industries,competent, analytical, and affable with strong problem-solving abilities and a focus on credit collection. demonstrated to increase process efficiency while upholding strict customer service standards.

Overview

22
22
years of professional experience

Work History

Global Treasury Manager for Healthcare: Manager of Finance and Quality/Claims Integrity Specialist

IHMS (A Medi Assist Co.)
04.2009 - Current
  • Manages several departments within the Payment Operations group(s)
  • Manage the day-to-day accounts receivable (A/R) operations
  • Research claim denials and prepare and submit appeals
  • Ensure accurate and timely medical coding using ICD-10 and CPT coding systems
  • Performs performance management, determines training and development needs, and sets performance standards for the division or unit
  • Collaborate effectively with team members, demonstrating problem-solving skills and excellent judgment
  • Identify and coordinate primary payment of claims to prevent or reduce payment/overpayment
  • In order to manage high value payments and FOREX releases and serve as the second level escalation contact, analyses client data
  • Utilize SQL queries to achieve optimal results
  • Engage in resolution negotiations by calling patients and guarantors in accordance with state and HIPAA laws
  • Communicate with others in a courteous and effective manner
  • In order to initiate the billing process, update accounts with new insurance information from Medicare, Workers' compensation, and private insurance.

MIS Manager

MIS
02.2008 - 03.2009
  • Individualize criteria as needed for accurate business information and from an operations standpoint
  • Communicate with clients to bring accounts up to date with appropriate payments schedules
  • Creating deviation and project monitoring reports; keeping an eye on business promotion, customer relationship management, and administration; using funds and the budget; and managing departments, activities, and reports
  • Assisted with the cash application team and credit manager to ensure timely and accurate posting of remittances; analyses loss reports and reviewed with senior management to measure overall portfolio performance; Managed invoices for the organization through case receipts processing, bank reconciliations, and distribution of over 800 invoices each month; Oversaw the resolution of disputes and reconciliation for over 250 client accounts; tasks to efficiently accomplish service goals.

Team Leader

Aegis International BPO Services Ltd
03.2005 - 02.2008
  • In charge of prioritizing client escalations and creating daily, weekly, and monthly MIS reports
  • Ensuring that performance targets that are directly impacted by call quality are met; conducting quality audits (based on agent orders and strict adherence to own productivity); monitoring attendance; assisting trainees with the process of fulfilling training requirements; taking escalations on quality-related concerns.

Co-Ordinates

Mayfair India Ltd
03.2002 - 03.2005
  • Provide training for new hires
  • Coordinate quality assurance: system verification, policy/transaction entry, output verification, and internal personnel/customer instruction
  • Generate medical insurance policy coverage details in the organization web portal
  • Communicate with clients regarding insurance and related inquiries; Organize routine inventory reports (Client Specific)
  • Serve as an intermediary between underwriters and end clients - Examine recorded system issues; suggest fixes and comprehensive specifications
  • Create and carry out test conditions; carry out cycles of batch testing; confirm test outcomes; and report to higher management
  • Keep track of and record system support files for updated policies.

Education

Bachelor of Arts - Economics

Calicut University

Skills

  • Payment Integrity
  • Coordination of Benefits
  • Overpayment Identification
  • Subrogation
  • Coding/Clinical Error Identification
  • Reporting and Business Intelligence
  • Investigative research
  • Audit procedure
  • Troubleshooting
  • Team building
  • Credit and collections
  • Customer support
  • Working collaboratively
  • Quality assurance controls
  • Result oriented
  • Knowledge-Driven
  • Team Building
  • Business Analysis skills
  • Keen Learner
  • Excellent Communication
  • Interpersonal Skills
  • People/Team management

Accomplishments

  • SQL Developer
  • Master Business Intelligence Tool
  • Tableau
  • Power BI
  • Informatica
  • Azure Data Factory

Awards

  • Won the “Spotlight Award” for outstanding contribution towards the team’s success.
  • Received email and verbal appreciations from customers for solving queries.
  • Consistently maintained debt collection targets and closed several old cases by getting in touch with customers, explaining the situation backed by timely call-backs which ultimately led to collections.
  • Received certificate of appreciation from client because for achieving customer satisfaction scores.

References

References available upon request.

Timeline

Global Treasury Manager for Healthcare: Manager of Finance and Quality/Claims Integrity Specialist

IHMS (A Medi Assist Co.)
04.2009 - Current

MIS Manager

MIS
02.2008 - 03.2009

Team Leader

Aegis International BPO Services Ltd
03.2005 - 02.2008

Co-Ordinates

Mayfair India Ltd
03.2002 - 03.2005

Bachelor of Arts - Economics

Calicut University

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BAIJU THAMBY