Chandru Kumar R
Bengaluru
Summary
Experienced Senior Process Associate with over 4 years in claims adjudication and US healthcare. Skilled in processing claims accurately, resolving issues, and ensuring compliance with healthcare regulations. Strong problem-solving abilities and a focus on improving workflows and efficiency. Looking to contribute my expertise to a healthcare organization in the US.
Overview
4
4
years of professional experience
Work History
Program specialist
Fortrea
09.2024 - Current
- Processing US healthcare insurance claims daily wise with quality production with SLA.
- Validation of eligibility criteria and Proof of income documents to verify patients and validate patient billed with correct provider's as per the process guidelines.
- Working for Lillypap project and analysis of clients fax application and update in system tools as per client requirements.
- Processing Healthcare Fax applications received from patients and providers and working as per process guidelines with accuracy.
- Maintaining Quality and meeting production with 100% accuracy.
Senior Process Consultant Operations
Sagility India Private Ltd
09.2020 - 09.2024
- Claims Adjudication: Processed and adjudicated claims for accuracy, compliance, and timely resolution, ensuring alignment with payer policies and US healthcare regulations.
- Reconciliation: Managed overpayment and underpayment cases, conducted detailed reconciliation, and implemented corrective actions to minimize errors and discrepancies..
- UB-04 and CMS-1500 Forms: Reviewed and processed claims using industry-standard forms, including UB-04 and CMS-1500, ensuring compliance with payer requirements.
- Dental and Radiology Claims: Specialized in adjudicating dental and radiology claims, resolving discrepancies, and ensuring accurate reimbursement.
- Payment Posting:Accurately posted payments, adjustments, and denials in the system while reconciling accounts for balanced reporting.
- Issue Resolution: Investigated and resolved escalated claim discrepancies, denials, and escalations, ensuring prompt resolutions and stakeholder satisfaction.
- Workflow Optimization: Identified inefficiencies in claim processing workflows and recommended process improvements to enhance operational efficiency.
- Compliance Management: Maintained up-to-date knowledge of US healthcare regulations (HIPAA) and payer-specific guidelines to ensure full compliance in claims handling.
- Claim Quality and Accuracy: Reduced claim processing errors by implementing detailed quality checks and reconciliation procedures.
Education
MBA - Finance And Marketing
Bangalore University
Bengaluru06-2019
Bachelors of Commerce - Finance And Marketing
Bangalore University
Bengaluru06-2017
Skills
- Adjudication
- Quality assurance
- Quick learner
- Reconciliation
- Workflow Optimization
- Critical thinking
Accomplishments
- Awarded as Top Gun for 100% Attendance, Quality, and high production.
Languages
English
Kannada
Telugu
Declaration
I do hereby declare the authenticity of all the information in my resume.
Timeline
Program specialist
Fortrea
09.2024 - Current
Senior Process Consultant Operations
Sagility India Private Ltd
09.2020 - 09.2024
MBA - Finance And Marketing
Bangalore University
Bachelors of Commerce - Finance And Marketing
Bangalore University
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