M DIVYASHREE
Chennai
Summary
Detail-oriented AR Caller with years of experience in healthcare revenue cycle management, specializing in resolving claim denials, payment posting, Adept at working in high-pressure environments with a proven track record of optimizing account receivables and achieving high claim resolution rates. Skilled in US healthcare regulations, HIPAA compliance, and insurance policies.
Overview
7
7
years of professional experience
Work History
Ar Process Executive
Omega Healthcare
09.2024 - Current
- As experience with Denial management with AR caller Expertise in (Physician Billing) process in CMS-1500
- Handled end-to-end claims processing, including follow-up on unpaid claims, resolving denials, and submitting appeals.
- Collaborated with insurance companies to expedite claim resolutions and ensure timely reimbursements.
- Verified patient insurance coverage and eligibility before claim submissions.
- Followed up with insurance payers on outstanding claims and processed payment adjustments.
- Maintaining client SLA with high quality.
- Acting as escalation point of contact for team.
- EOB Analysis,claims followup.
- Communicated with insurance companies in the US to resolve unpaid claims and reduce outstanding accounts receivables .
- Conducted follow-up on pending claims and initiated appeals for denied claims to ensure timely reimbursement.
- Verified patient insurance details and eligibility before claim submission, reducing errors in processing.
Process Associate
Tata Consultancy Services
01.2018 - 01.2023
- Over 5 years of experience as process associate - USD INVESTIGATION (SWIFT PAYMENT) for the client of CITIBANK in the field of banking domain.
Education
B.Com -
C.T.T.E COLLEGE FOR WOMEN - Madras University
01.2017
H.S.C -
Kaligi Ranganathan Montford Matriculation Higher Secondary School
01.2014
S.S.L.C -
Kaligi Ranganathan Montford Matriculation Higher Secondary School
01.2012
Skills
- Effective Communication: Engaging with patients and insurance providers to resolve issues
- Data Analysis and Reporting: Analyzing claim trends and generating reports
- Medical Billing and Coding: Familiarity with medical billing processes and coding
- HIPAA Regulations: Ensuring compliance with patient privacy laws
- Team Collaboration: Working with teams to streamline claim resolution
- Payment Reconciliation: Ensuring accurate payment processing
- Insurance Verification: Verifying insurance coverage and eligibility
- Customer Relationship Management: Maintaining positive relationships with patients and insurance companies
- Root Cause Analysis: Identifying and addressing the causes of claim denials
- Claim Denial Management: Resolving claim denials and submitting appeals
- Insurance Claims Guidelines: Navigating through insurance policy guidelines to ensure accurate claim processing
Languages
- English
- Tamil
Languages
Tamil
First Language
English
Intermediate
B1
Timeline
Ar Process Executive
Omega Healthcare
09.2024 - Current
Process Associate
Tata Consultancy Services
01.2018 - 01.2023
B.Com -
C.T.T.E COLLEGE FOR WOMEN - Madras University
H.S.C -
Kaligi Ranganathan Montford Matriculation Higher Secondary School
S.S.L.C -
Kaligi Ranganathan Montford Matriculation Higher Secondary School