HEMALATHA V
Chennai,TN
Summary
Detail-oriented Eligibility and Authorization Executive with 4.5 years of experience in verifying patient eligibility, securing prior authorizations, and ensuring accurate insurance coverage for medical services. Skilled in resolving discrepancies, reducing claim denials, and ensuring seamless communication between patients, providers, and insurance companies. Strong attention to detail, commitment to compliance, and a focus on training and supporting team members to drive efficiency and improve patient service.
Overview
9
9
years of professional experience
Work History
Senior Process Executive
Cognizant Technology Solution
03.2022 - 10.2024
- Verify eligibility and benefits for patients prior to appointments, ensuring services are covered by insurance, which minimizes claim denials and delays.
- Obtain prior authorization for all outpatient services by submitting necessary documentation to insurance companies and following up on approval status.
- Complete daily task responses and emails regarding patient eligibility, authorizations, and appointment updates, ensuring timely and accurate communication with both patients and healthcare providers.
- Close all 0-14 appointments daily, ensuring that all patient schedules are current and accurate.
- Efficiently handle eligibility and authorization tasks for multiple practices, ensuring that all requirements are met on time without escalation or issues.
- Provide guidance and training to new associates, addressing questions and helping them become proficient in eligibility verification and authorization processes.
Senior Client Service Executive
Medusind Solution
02.2020 - 03.2022
- Verify patient information with the insurance carrier (verification of eligibility & benefits, co-pays, co-insurances, deductibles, patient policy status, effective date, type of plan, coverage details and claims mailing address).
- Verify and update patient demographics for new patients, ensuring all information is accurate and up-to-date in the system for billing and communication purposes.
- Provide software training and guidance to new team members, ensuring they are proficient in using client software for eligibility verification.
- Maintaining proper documentation on the client software to send necessary documents to insurance companies.
- Ensure all tasks are completed in adherence to healthcare regulations, HIPAA guidelines, and company policies
Senior Customer Care Executive
QConneqt Business Solutions
11.2017 - 02.2020
- Managed a high volume of inbound calls from customers, addressing queries, resolving complaints, and processing requests efficiently.
- Effectively handled customer complaints, providing appropriate solutions and following up to ensure customer satisfaction
- Ability to handle 120-150 calls per day.
- Responsible for monitoring, identifying, and hot-listing debit and credit cards that are reported lost, stolen, or flagged for fraudulent activity to prevent unauthorized transactions.
- Provide the solutions to customers as per their concern & update the same in CRM process
- Change DSAT customer to CSAT customer
Service Level Coordinator
Care It Solution
03.2016 - 03.2017
- Experience in ensuring high volume calls
- Knowledge of telephone etiquette
- Ability to type 40-50 words per minute
- Monitoring call management system to ensure SLA is met
- Ensure that customer service engineers are assigned to calls
- Monitoring white space on call systems to improve productivity of engineers
- Allocating calls to engineers on daily basics and monitoring the same till closure
- Handling the field escalation from engineers and providing solutions
- Change DSAT customer to CSAT customer
Education
Diploma in Electronics And Communication Eng. -
P. T. Lee Chengalvaraya Naicker Polytechnic College
04-2015
Bachelor in Computer Application -
University of Madras
Chennai, India04-2015
Skills
- Eligibility & Benefits Verification
- Healthcare Regulations & Compliance
- Multi-tasking & Time Management
- Problem Solving & Critical Thinking
Languages
English
Tamil
Hobbies and Interests
- Listening to Music: Enjoy exploring music in various languages, which uplifts my mood and brings me joy.
- Playing Keyboard: Passionate about playing the keyboard, which enhances focus, discipline, and creativity.
Disclaimer
I hereby declare that the information provided in this resume is true, accurate, and complete to the best of my knowledge. Any misrepresentation or omission is unintentional and will be corrected promptly upon notification.
Timeline
Senior Process Executive
Cognizant Technology Solution
03.2022 - 10.2024
Senior Client Service Executive
Medusind Solution
02.2020 - 03.2022
Senior Customer Care Executive
QConneqt Business Solutions
11.2017 - 02.2020
Service Level Coordinator
Care It Solution
03.2016 - 03.2017
Diploma in Electronics And Communication Eng. -
P. T. Lee Chengalvaraya Naicker Polytechnic College
Bachelor in Computer Application -
University of Madras
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