DIVYA SREE DUDURPALA

In order to resolve patient claims, I am answering provider inquiries, processing the end-to-end adjustments, and taking action on the claims.
I have an excellent track record in processing claims adjustments in all scenarios for the end-to-end process, IQT creation, checking medical records, appeals, and grievances. CMS 1500 and WCF form.
Good knowledge of various applications like PEGA, NextGen, McKesson, Cotivity, WCF, CMS 1500 form, Front of Benefits System (FOBs), EOC, CIW, ASPEN, Check Inquiry Tool, Concord, and WellPoint Group System (WGS).
Good knowledge of processing the claims end-to-end process with scenarios like corrected claims, duplicate claims, authorization (pre-auth and retro-auth), eligibility, timely filing, limited liability, and benefit coding, professional claims, facility claims, inpatient claims, Medicare claims, and outpatient claims.
Good knowledge of medical records reviewing, appeals and grievances, clinical documentation, and HIPAA regulations in documentation.
Good knowledge of PAR and NON-PAR claims.
Good knowledge of PPO, HMO, EPO, and POS networks.
Good knowledge of the explanation of benefits.
Good knowledge of denials.