KAKU SRI VAISHNAVI REDDY
Hyderabad
Summary
Detail-oriented RCM professional with over 3.6 years of experience in the U.S. Healthcare eligibility and benefits verification, claims resolution, and denial management. Proficient in verifying insurance coverage, reviewing copay, deductible, and coinsurance details, and identifying authorization/referral requirements using portals like Availity, NaviNet, UHC, and BCBS. Skilled in resolving eligibility-related denials (e.g., CO-27), documenting payer communications, and ensuring clean claim submission. Proven ability to maintain high production with 98%+ quality scores in fast-paced environments. Strong communicator with experience supporting both front-end and back-end RCM workflows
Overview
3
3
years of professional experience
Work History
Senior Process Executive
Ranaha Business Consultants
Hyderabad
07.2024 - 04.2025
- 1st July 2024- 30th April 2025
- Portals: Availity, NaviNet, UHC, and BCBS.
- Key Responsibilities:
- Responded promptly to inquiries from providers regarding eligibility verification or other issues concerning managed care operations.
- Provided case management services including assisting with referrals, authorizations, eligibility verification, and benefits coordination.
- Resolved issues related to registration process including eligibility verification and authorization problems.
- Prioritized and organized tasks to efficiently accomplish service goals.
- Coordinated insurance eligibility verification, prior authorizations, referrals, and claims processing.
Senior Process Executive – US Healthcare
Cognizant Technology Solutions
Hyderabad
11.2021 - 06.2024
- 5th Nov 2021- 17th June 2024
- Portals: Availity, NaviNet, Palmetto, UHC, I Blue Link, Medicaid
- Key Responsibilities:
- Performed insurance eligibility and benefits verification for professional and institutional services using portals like Availity, NaviNet, UHC, and BCBS.
- Verified plan details, including effective/termination dates, copay, deductibles, coinsurance, and out-of-pocket limits.
- Identified and flagged authorization/referral requirements for scheduled services to prevent delays or denials.
- Resolved eligibility-related denials (e.g., CO-27) through accurate re-verification and root cause analysis (RCA).
- Documented all verification details, with reference numbers and payer call notes, in the internal billing system.
- Coordinated with the billing and AR teams to ensure timely claim submission and proper patient responsibility collection.
Education
Bachelor of Commerce - Computer Applications
Sri Nethaji Degree College
Nellore03-2020
Skills
- Eligibility and benefits verification (EVBV)
- Denial management
- Authorization and referral verification
- Revenue Cycle Management (RCM)
- Insurance portals and tools
- Communication and coordination
- Production and quality
- Claims processing
Languages
English, Hindi, Telugu
Disclaimer
I hereby declare that the information provided above is true and accurate to the best of my knowledge. Signature K. Sri Vaishnavi
Timeline
Senior Process Executive
Ranaha Business Consultants
07.2024 - 04.2025
Senior Process Executive – US Healthcare
Cognizant Technology Solutions
11.2021 - 06.2024
Bachelor of Commerce - Computer Applications
Sri Nethaji Degree College
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