Heramba H S

Project Description.

Handled patient verification calls, confirming identity and insurance details to ensure accurate data for billing and eligibility verification.

Roles and Responsibilities

• Led a team of 15 members in the U.S. healthcare voice process, consistently achieving team goals related to quality, productivity, and customer satisfaction.
• Monitored team performance through daily reports and real-time monitoring, ensuring adherence to KPIs like First Call Resolution (FCR), Average Handle Time (AHT), and Customer Satisfaction (CSAT).
• Trained and mentored new hires, facilitating onboarding, and providing continuous support to ensure team members’ compliance with healthcare regulations (HIPAA, CMS).
• Preparing SLA/KRA, which was proposed internally and externally.
• Handled escalated customer calls, resolving complex healthcare-related issues with empathy and professionalism, to maintain high satisfaction levels.
• Analyzed key performance metrics and developed action plans to address performance gaps, leading to improvements in service delivery, and reduced error rates.
• Ensured strict adherence to HIPAA guidelines and industry regulations, conducting periodic audits and training to minimize compliance risks, and maintain data integrity.

Project Description

Joined Infosys as a Team Lead for Appeals, able to gain more experience in leading a team successfully. I was able to manage a team of 28 persons with a minimal attrition percentage, meeting the SLA/KRA that was proposed internally and externally.

Roles and Responsibilities

• Managing a team of 28 members.
• Managing inventory and ensuring that they complete the task within the TAT period, with customer standards and quality.
• Responsible for timely and accurate MIS reports on a weekly/monthly basis.
• Providing feedback on daily targets met by the team, and resolving their queries.
• Attending client calls on a weekly basis to discuss the production, quality.
• Providing the individual overall performance feedback by conducting a one-on-one session.
• Maintaining attrition and shrinkage percentages per company standard.
• Preparing the SLA/KRA that was proposed internally and externally.
• Identifying training needs for bottom performers
• Reviewing and verifying large volumes of data.
• Timely submission of electronic and/or paper claims.

Project Description

I joined HGS as a Senior Process Associate in the Aetna project. Processing health insurance claims for Europe, Singapore, and the Hong Kong region by checking medical claims from overseas in terms of medical prescriptions, invoices, and analyzing member eligibility coverage through the TOB portal. By examining the above details, we require processing the claim by creating an invoice line and a Beneficiary summary in the ERP, sent for approval, supporting the implementation of quality assurance by auditing tasks on a regular basis, and forging ahead to complete tasks through the payment mode within the scheduled date, and identifying that a claim has been denied and investigating the root cause of the denial.

Roles and Responsibilities:

• Handling escalations by interacting with clients and customers through mail.
• Monitoring the day-to-day inventory and tasks assigned to the team.
• Ensuring that the claims are handled within the TAT.
• Allocate work to team members.

Achievements:

• Awarded Top Gun of the Month six times.

Project Description

I joined Omega Healthcare as a Trainee Coder in the Centrex Project, and I worked as a QCA (Quality Control Analyst). Working in ambulance coding, ambulance coding involves determining the medical necessity for a patient who requires an ambulance for transport to a hospital or to some other medical centers. By using the patient EPCR (Electronic Patient Care Report), the agent will bill that particular report, which is called TRIP. Billing a trip involves determining medical necessity, providing a diagnosis code for a patient's condition by using a condition code spreadsheet, and verifying and activating the patient's health insurances attached to the EPCR. I temporarily worked on the TUG project regarding provider billing for office visits. Entering the clinical visit charges on software as listed data, such as place of service, facility, DOS, procedure codes, ICD-10 codes, modifiers, and fee values as per the superbill.

Roles and Responsibilities:

• Solving the issue, like Trip, diagnosis code.
• Participation in the team meetings.
• Follow the SOPs.