Gokul S

• Developing methods of measuring if performance management aligns with organizational goals

• In-charge for bringing process improvement like increasing, reducing issue logs, and identifying trends

• Partnering with departments and business units to identify gaps in employees' corporate competencies, and recommending solutions to close these gaps

• Preparing weekly sampling plan for the team members and tracking their attendance and production on a daily basis

• Creating training modules as needed for process improvements

• Scheduling every day in status planner or task planner

• Concentrating on production target, planning daily activities for team members, and sharing of process knowledge

• Analyzing all team work performance and ensuring achievement of all objectives within required deadlines and monitoring all system functionality

• Managing service operations for rendering quality and providing first line client satisfaction

• Monitoring the progress of team members and delivering constructive feedback.

Extensively used MEDITECH,CERNER and EPIC software.

Patient Insurance:

• Starting from the policy coverage checking active coverage available for the Date of Service.
• Pre analyzing the claim and denials occurred and working for the denials.
• Explaining the insurance representative about the denial and reprocessing the claim from their end.
• Verifying the payments received from their insurance end to the correct member account.

Denial Separation:

• According to the denials, separating the claims and giving them a correct Action and Result code.
• Following the claim till the payment received from the payor end.
• Making regular call back according to the specified payor time chart.
• Submitting medical records supporting the service rendered.

Payment Follow up:

• Posting the Explanation of benefits and the payment received from the payer end.
• Balance posting for adjustment and overpayment
received from the payer.
• For overpayment scenario sending refund and check clearance, Electronic payment update.
• Challenging part of this work is Record is creating.

Update and submit for approval should follow same procedure as internal User.

Portal Navigation:

• Checking claim status, eligibility in payer portals i.e., Availity, one source, Navinet.
• Sending enquires to the portal and resolving the claims.

Patient Insurance:

• Starting from the policy coverage checking active coverage available for the Date of Service.
• Pre analyzing the claim and denials occurred and working for the denials.
• Explaining the insurance representative about the denial and reprocessing the claim from their end.
• Verifying the payments received from their insurance end to the correct member account.

Denial Separation:

• According to the denials, separating the claims and giving them a correct KICK.
• Following the claim till the payment received from the payor end.
• Making regular call back according to the specified payor time chart.
• Submitting appeal letters and medical records supporting the service rendered.

Payment Follow up:

• Posting the Explanation of benefits and the payment received from the payer end.
• Balance posting for adjustment and overpayment
received from the payer.
• For overpayment scenario sending refund and check clearance, Electronic payment update.
• Challenging part of this work is Record is creating,
Update and submit for approval should follow same procedure as internal User.