Gokila Subbian

• Working in QuickBooks (accounting) for the US Clients
• Maintaining US Clients Timesheets, invoice, audit which accounts for payroll
• Following up with Client for Timesheets and ensuring that timesheets are up to date for the Clients.

• Worked in EDMS (Events Database Management System): Verifying details from Clients and updating Database.

• Health Net, Inc
• Is an American health care insurance provider
• HMO, POS, insured PPO and government contracts subsidiaries provide health benefits to approximately 5.9 million individuals in all 50 states and the District of Columbia through group, individual, Medicare, Medicaid, Tricare and Veterans Affairs programs.

Receive and review medical and hospital claims checking for completeness and compliance with established policies and procedures

Review claims for authorization and member eligibility as necessary

Complete all claims processing functions within the regulated timeframe of 30 days to deny and 45 days to pay

Input claims onto the claims processing system and correct any discrepancies as necessary

Run batch control report and balance payment totals

Work EDE electronic claim queues to correct, modify, and transfer to different queue for additional research

Identify high balance claims for management review and approval

Identify procedures requiring pricing and transfer to the EDI Claims Coordinator

Process coordination of benefit claims for balance after primary insurance payment, deductibles or co-payments

Access GTESS to verify EDE claim information and update data entries as necessary