Kalpanashree Gurumoorthy
Coimbatore
Summary
Dedicated professional with strong negotiation skills and proven experience in team management, quality analysis, and accounts receivable processes. Consistently delivers timely and accurate results, demonstrating a clear understanding of business procedures. Possesses excellent analytical and organizational abilities, with a commitment to continuous learning and skill development. Effective communicator and team player, capable of managing multiple tasks and adapting to diverse situations.
Overview
11
11
years of professional experience
Work History
Program Assistant
Fortrea Patient Access India Private Limited
Bangalore
07.2023 - Current
- Analyzed billing reports for KPIs such as collection percentages and claim denial rates.
- Resolved denied or rejected claims swiftly, maintaining consistent communication with insurance providers.
- Ensured adherence to HIPAA regulations, payer-specific guidelines, and healthcare laws.
- Assisted in developing strategies to improve existing programs or create new ones based on stakeholder feedback or changing needs within the community served by the organization's services.
- Participated in weekly team meetings to provide updates on individual projects and assist colleagues with any issues they may have encountered during their work.
- Assisted in the coordination of program activities and resources, including scheduling meetings, preparing materials, and providing administrative support.
- Maintained detailed records of all program activities, data collection, and evaluation results.
- Fostered relationships to define programming needs and strengthen organizational standing.
- Maintained positive working relationship with fellow staff and management.
- Maintained front desk to provide positive first impression.
- Provided HR administrative assistance to management team.
- Coordinated support to facilitate general office operations.
- Provided technical assistance to program participants by responding to inquiries via phone or email.
- Organized special events such as conferences, workshops, training sessions. for program participants.
- Collaborated with cross-functional teams to develop innovative solutions for complex challenges.
- Collaborated with other departments to ensure smooth delivery of services for program participants.
- Oversaw comprehensive billing operations from coding validation to account reconciliation.
- Worked in partnership with coding and clinical teams to tackle billing-related challenges.
- Provided training for billing staff, guiding performance improvements when required.
- Developed and updated billing policies alongside standard operating procedures.
- Produced and distributed memos, newsletters, and other forms of communication.
- Produced well-written, comprehensive reports and documents.
- Partnered with program management on recommendations, process improvements, and corrective action plans.
Subject Matter Expert
Access Healthcare India Private Limited
Chennai
07.2021 - 03.2023
- Track Associate performance and its impact on the project.
- Gives constructive feedback to associates and derive action plan.
- Communicating with the client on a regular basis related issue/updates and timely delivery of all the jobs assigned.
Senior Quality Analyst
Logix Health Solutions Pvt Ltd
Coimbatore
10.2017 - 07.2021
- Joined as an AR Caller and promoted as a Quality associate in IJP.
- Role is to work on the AR report thoroughly and to close, follow-up the denied claims and need to call and complete the action within the TAT.
- Shared daily Quality production details and coverage reports and other process related reports to Team lead.
- The primary roles and responsibilities are to generate AR report and work on the report.
- Reviewing and appealing for the unpaid and denied claims.
- Work directly with the insurance carrier, healthcare provider to have claims processed and paid.
- To work on the rejected claims in clearing house.
- Prepared reports summarizing quality inspection activities, results, trends, findings, conclusions, and recommendations.
- Reviewed customer feedback data to identify areas for improvement in product design and development.
US Medical Billing –AR Caller
VEE Technologies
Salem
08.2014 - 08.2017
- Role is to call the insurance and get the status of the claim, take particular action for the denial.
- To work on the rejected claims in clearing house.
- Followed all federal, state, and local laws related to collections practices.
- Performed monthly reviews of aging reports for assigned accounts.
- Participated in team meetings to discuss best practices for AR calling strategies.
- Researched and resolved discrepancies between patient accounts and third-party payers.
Education
B.Tech - IT
Vidyaa Vikas College of Engineering & Technology
Namakkal04-2014
XII -
RKV Mt. Hr. Sec School
Kovaipudur, Coimbatore05-2010
X -
Gurukulam High School
Kovaipudur, Coimbatore05-2008
Skills
- Kareo and ECW systems
- Epic and Siebel platforms
- CMD proficiency
- Team collaboration
- Claims resolution
- Process improvement
- Constructive feedback
- Performance tracking
- Service delivery management
- Report preparation
- Project management
- Meeting facilitation
- Research skills
Disclaimer
I hereby declare that the information furnished above is true and accurate to the best of my knowledge and belief.
Personal Information
- Father's Name: Gurumoorthy R
- Date of Birth: 03/30/93
- Marital Status: Married
Timeline
Program Assistant
Fortrea Patient Access India Private Limited
07.2023 - Current
Subject Matter Expert
Access Healthcare India Private Limited
07.2021 - 03.2023
Senior Quality Analyst
Logix Health Solutions Pvt Ltd
10.2017 - 07.2021
US Medical Billing –AR Caller
VEE Technologies
08.2014 - 08.2017
B.Tech - IT
Vidyaa Vikas College of Engineering & Technology
XII -
RKV Mt. Hr. Sec School
X -
Gurukulam High School
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