Work Type
Full TimeLocation Preference
On-SiteRemoteLocation: MANNARKKAD, Palakkad
Open to relocation: Yes
GOWTHAM KRISHNA
Senior Executive Insurance
MANNARKKAD
Work Preference
Summary
Detail-oriented Hospital Insurance and Claims Professional experienced in TPA and government insurance schemes, inpatient and outpatient billing, and claim processing. Skilled in pre-authorization, query resolution, and documentation verification, ensuring compliance with insurance guidelines and facilitating effective claims workflows across multiple hospitals.
Overview
5
5
years of professional experience
Work History
HCMD Executive
KIMS Alshifa Healthcare Pvt. Ltd.
08.2023 - 10.2026
- coordinated inpatient (IP) and outpatient (OP) billing for TPA and government insurance schemes, ensuring accurate documentation.
- Managed claims workflow by coordinating pre-authorization and completing settlement follow-ups to ensure timely reimbursements.
- Resolved billing discrepancies in coordination with cross-team stakeholders while handling insurance claim queries.
- Directed cross-team coordination among billing, medical records, and front-office teams to improve accuracy in insurance operations.
- Managed documentation alignment with insurance requirements and hospital protocols to support audit readiness.
- Verified billing record documentation and correspondence accuracy to uphold compliance standards.
Intern - Python Data Science
Luminar Technolab
01.2023 - 06.2023
- Supported development and testing efforts for Python-based data science projects to strengthen project outcomes.
- Performed data cleaning and preprocessing with Python libraries to support accurate analysis through improved data quality.
- Streamlined data visualization report generation, alongside Python scripting, to support analytical tasks and deliver actionable insights.
- Documented project requirements, updates, and technical changes for team coordination.
Claim Analyst
7Sigma Healthcare Pvt. Ltd.
06.2021 - 08.2022
- Streamlined daily IP and OP billing and claim processing workflows for six hospitals to support accurate and timely submissions.
- Managed TPA and government insurance scheme claims by verifying accuracy, and following up on settlements for faster processing.
- Cleared billing discrepancies while handling insurance queries, facilitating prompt claim processing, and reducing delays.
- Streamlined high-volume workflows while completing documentation within daily deadlines.
- High-volume customer calls were handled efficiently, supporting consistent service quality.
- 10% revenue growth resulted from responsive customer service, and proactive outreach.
Education
B.Sc. - Mathematics
Bharathiar University
Coimbatore, India01-2020
NACTET - Python Data Science
NACTET
Kozhikode, India 04.2001 -
Skills
Inpatient outpatient billing
Medical Claim Processing
TPA & Government Insurance Claims
Pre-authorization coordination
Claim verification
Claim follow-up
Claim resolution
Revenue cycle management
Insurance Verification
EDUCATION & TRAINING
Python Data Science | NACTET | 2023
Timeline
HCMD Executive
KIMS Alshifa Healthcare Pvt. Ltd.
08.2023 - 10.2026
Intern - Python Data Science
Luminar Technolab
01.2023 - 06.2023
Claim Analyst
7Sigma Healthcare Pvt. Ltd.
06.2021 - 08.2022
NACTET - Python Data Science
NACTET
04.2001 -
B.Sc. - Mathematics
Bharathiar University