Harinni S

SME (SUBJECT MATTER EXPERT)

Exela technologies Pvt ltd

06.2024 - Current

Key Responsibilities:
Claim Assignment and Coordination:
Assigned incoming claims to appropriate teams based on payer requirements and claim complexity.
Coordinated with internal teams to ensure smooth claim workflow and timely submissions.
Monitored claim queues and prioritized urgent cases for faster resolution.
Claim Adjudication:
Reviewed and adjudicated claims for accuracy, completeness, and compliance with insurance policies.
Resolved claim discrepancies and minimized denials through proactive follow-up and corrections.
Maintained up-to-date knowledge of payer-specific adjudication policies.
Payment Posting:
Accurately posted insurance payments, patient payments, and adjustments into billing systems.
Reconciled posted payments with Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs).
Identified and escalated payment discrepancies, under payments, and overpayments.
Subject Matter Expert (SME) Responsibilities:
Acted as a SME for billing workflows, claims adjudication, and payer guidelines.
Provided training, mentoring, and support to new and existing billing team members.
Assisted leadership with audit preparation and internal quality reviews.
Process Improvement and Team Collaboration:
Collaborated with billing, coding, and collections teams to improve process efficiency.
Recommended improvements to claim handling procedures, reducing processing time and errors.
Participated in team meetings focused on operational excellence and revenue optimization.
Spearheaded process improvements that reduced bottlenecks, resulting in enhanced project timelines and resource allocation.