Irshath Ahamed S
Thanjavur
Summary
HIPAA-certified, highly-skilled, self-motivated Team Leader at Assembly Health with proven track record in delivering high-quality services punctually while adhering to strict deadlines and elevated expectations.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Team Leader
Assembly Support/Clinicanywhere
IL
07.2019 - Current
- Monitor team performance regularly, identify areas for improvement, and implement corrective actions to drive efficiency and quality outcomes.
- Foster a supportive and collaborative team environment, promoting strong employee relationships, and sustained engagement.
- Working on escalated claims by the team and providing training on reducing escalation to ensure accurate and timely resolution.
- Develop and execute performance improvement plans based on data-driven monitoring insights.
- Resolve complex client inquiries in coordination with NextGen systems and dedicated Account Managers.
- Lead the successful onboarding of new clients by establishing Standard Operating Procedures (SOPs), and ensuring compliance with organizational and regulatory standards.
- Collaborate with clients and compliance teams to correct provider maintenance errors, ensuring data accuracy and integrity.
- Ensure strict adherence to compliance guidelines, including rules related to incidental billing and dual-provider scenarios.
Senior Revenue Cycle Executive - Physician Billing
Sutherland Global
04.2016 - Current
- Handled high-value claim follow-ups, ensuring timely resolutions and maximized reimbursements.
- Collaborated with providers across specialties, including Neurology, ENT, Pediatrics, and DME supplies.
- Managed comprehensive follow-up processes, addressing rejections, denials, appeals, reconsiderations, and AR calls.
- Maintained accurate collection data to optimize Gross Collection Rate, Net Collection Rate, and Accounts Receivable days.
- Conducted patient registration by accurately entering demographics and insurance details.
- Verified patient eligibility and benefits before services to prevent delays or denials.
- Created and submitted compliant claims to insurance carriers to ensure timely processing.
- Obtained prior and retro authorizations for services to facilitate efficient claim processing.
Senior Revenue Cycle Executive in DME Billing
Accesshealthcare
11.2014 - 04.2016
- Processed Medicare and Medicaid claims for durable medical equipment billing.
- Resolved claims using Certificate of Medical Necessity and related concepts.
- Applied grandfathering supplier rules to successfully resolve Medicare claims.
- Managed various levels of Medicare reconsideration and redetermination processes.
- Submitted Medicaid claims online, ensuring prompt payment.
- Achieved Best Quality Finding Award in Groove, 2015.
- Led virtual initiatives with Access HealthCare, collaborating with diverse practices and providers.
AR Caller- physician Billing
TechnoSoft Global
11.2013 - 10.2014
- Managed clearinghouse and payer path rejections, ensuring prompt resolution of claim issues.
- Utilized GE Healthcare software to resolve rejected claims related to eligibility and coding discrepancies.
- Corrected and resubmitted claims as clean submissions according to payer guidelines.
- Performed precise cash posting and denial posting to maintain accurate financial records.
- Specialized in medical claim submissions via payer portals to expedite processing and payment.
Education
A Bachelor of Engineering (BE) - Computer Science
St Joseph College Of Engineering
Tamilnadu, India11-2015
Skills
- Healthfusion
- AdvancedMD
- Kareo
- OfficeAlly
- Therabill
- ECW
- Emedsys
- TCMS
- ETM-nextgen
- Medisift
- IDX tools
- Brightree
- Citrix-Nextgen
- Emdeon
- Capario
Provider Specialty
- Chiropractic
- Psychology
- Mental health
- Acupuncture
- Family practice
- Internal medicine
- Cardiology
- Radiology
- Podiatry
- Gynecology
- DME billing- oxygen and supplies, CPAP and supplies, hospital bed, Walkers and Wheel Chair, Humidifier and supplies.
Certification
- HIPAA officer Completion Certificate, PCIHIPAA, 01/01/2023
- Basic Coding Knowledge Certificate, Nittany Institute
Coding Knowledge
- Claim Adjudications
- ICD-10 codes/HCPCS codes
- Medical terminology
- Medicare and Medicaid guidelines
- Knowledge of payer reimbursement characteristics and billing policies
- Medical Documentation review and Auditing
- Coding correction by reviewing payer clinical and reimbursement medical policies, like LCD policies, CPB policy with Aetna, McKesson Edit, NCCI Edit, encoder, and Codify tools
COMPLIANCE KNOWLEDGE
- Federal False Claims Act
- Minimum necessary standard
- Abuse act
- Fair Debt Collection Act
Languages
Tamil
First Language
English
Proficient (C2)
C2
Timeline
Team Leader
Assembly Support/Clinicanywhere
07.2019 - Current
Senior Revenue Cycle Executive - Physician Billing
Sutherland Global
04.2016 - Current
Senior Revenue Cycle Executive in DME Billing
Accesshealthcare
11.2014 - 04.2016
AR Caller- physician Billing
TechnoSoft Global
11.2013 - 10.2014
A Bachelor of Engineering (BE) - Computer Science
St Joseph College Of Engineering
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