Summary
Overview
Work History
Education
Skills
Accomplishments
Languages
Certification
Timeline
Generic

Dileep Kumar Ratnala

Hyderabad

Summary

Experienced Medical Claims Adjuster with deep knowledge of Professional and Institutional medical claims industry. Eager to continue being successful at contributing to meeting team goals by managing multiple priorities with a positive attitude, utilizing interpersonal skills, excellent time management and problem-solving skills. Strong reporting and research skills. Strong command of conflict resolution and negotiation combined with excellent reporting and research skills.

Overview

10
10
years of professional experience
1
1
Certification

Work History

Medical Insurance Claims Adjudicator/Trainer

Legato Health technologies
Hyderabad
01.2019 - 07.2022
  • Reviewed and adjudicated claims up to specified dollar limit
  • Processed claims within performance guidelines of the department, including quality and timeliness
  • Understands provider contracts
  • Examined and interpreted all relevant documents included with the claims
  • Responded to claim-specific questions and escalations as applicable
  • Partnered with leadership on any questionable claim activity
  • Understands logic of standard medical coding (i.e
  • CPT, ICD-10, HCPCS, etc.)
  • Determined accurate payment criteria for clearing pending claims based on defined Policy and Procedures
  • Researched claim edits to determine appropriate benefit application utilizing established criteria, applies physician contract pricing as needed
  • Worked high volume of repetitive claims
  • Identified claims with inaccurate data or claims that require review by appropriate team members
  • Completed special projects as assigned and supports other Claims Department team members in assigned projects
  • Complied with all departmental and Company policies and procedures
  • Consistently demonstrated compliance with HIPAA regulations, professional conduct, and ethical practice.

Process Executive

Cognizant technologies
Hyderabad
09.2014 - 01.2019
  • Auditing claims as per given updates from onshore
  • Provide Quality score reports periodically and minimize errors by following a statistical approach
  • Provide analysis on the adjudication and strive to automate the process of resolving medical claims
  • Review and update the SOP
  • Perform Claim adjudication report the status by EOD
  • Identify and appraise any gaps with in operational processes proactively to the Engagement Leadership and also suggest tactical remedies to the findings
  • Recognize any areas of concern within the Operations team and provide feedback
  • Conduct training programs across the project team and help them understand the process.

Research Analyst

Virchow Biotech Pvt Ltd.
06.2012 - 07.2014
  • Worked as a Research Analyst for 2 years at Virchow Biotech Pvt Ltd.

Education

B.Pharmacy - Pharmacy

Adarsa College of Pharmacy
04.2012

Intermediate - Bipc

Surya College
04.2008

High School Diploma -

Surya Model School
04.2006

Skills

  • Claim Form Analysis
  • Claims Procedures
  • Work consolidation
  • Coding review
  • Insurance Terminology
  • Team Training
  • Insurance Industry Experience
  • Claims Processing
  • Claims Evaluation
  • Critical Thinking
  • Decision Making
  • Team Collaboration
  • MS-Excel, Word and Power Point
  • Macros creations
  • Multi task handling

Accomplishments

  • Received multiple awards for the training given to multiple batches
  • Got appreciations from senior management for monthly and quarterly performance
  • Get rewarded for the accuracy scores maintenance consequently

Languages

Telugu
First Language
English
Proficient (C2)
C2

Certification

  • Trained Medical coder
  • Got certified as a professional trainer from Cognizant Technologies

Timeline

Medical Insurance Claims Adjudicator/Trainer

Legato Health technologies
01.2019 - 07.2022

Process Executive

Cognizant technologies
09.2014 - 01.2019

Research Analyst

Virchow Biotech Pvt Ltd.
06.2012 - 07.2014

B.Pharmacy - Pharmacy

Adarsa College of Pharmacy

Intermediate - Bipc

Surya College

High School Diploma -

Surya Model School

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Dileep Kumar Ratnala