M. SHOBANA
Chennai
Summary
Dedicated Medical Professional with a Bachelor of Homeopathic Medicine and Surgery (B.H.M.S.) and 4 years of specialized experience in eClaims & Reimbursement processing at Sutherland Healthcare. Expert at combining clinical knowledge of anatomy, pathology, and surgery with medical coding expertise to ensure accurate claims adjudication. Proven expertise in Reimbursement and Pre-authorization (Pre-auth) processes, ensuring seamless medical necessity reviews and high compliance standards.
Overview
4
4
years of professional experience
Work History
Medical Claims Analyst (eClaims & Reimbursement))
Sutherland Healthcare
Chennai
12.2021 - Current
- Spearheaded the Pre-authorization process, reviewing clinical documentation to approve medical necessity for specialized treatments.
- Managed the Reimbursement lifecycle, ensuring accurate payout for healthcare services based on policy coverage.
- Leveraged clinical background to validate diagnostic codes and treatment plans against policy guidelines.
- Reduced claim denial rates by identifying discrepancies between clinical documentation and billed services.
- Collaborated with healthcare providers and insurance carriers to resolve complex billing issues.
Certified Medical Coder
Yogam BPO
- Completed intensive training for medical coding and received professional certification.
- Translated clinical diagnoses and procedures into standardized medical codes for insurance billing.
Medical Trainee
JV Hospital, Kodambakkam, Chennai
Kodambakkam
- Performed preliminary patient examinations and diagnosed various medical conditions.
- Maintained detailed medical charts, recording vital statistics and patient history.
- Assisted senior doctors in administering medications and vaccinations.
- Operated medical diagnostic instruments and monitored test results for clinical accuracy.
Education
Intermediate -
SRV EXCEL H.S.S.
High School -
ST. ANDREW'S H.S.S.
B.H.M.S. - Anatomy, Pathology, Forensic Medicine, Surgery, and Practice of Medicine
Sri Sairam Homoeopathic Medical College and Research Centre
ChennaiSkills
- EClaims Processing
- Medical Claims Adjudication
- Revenue Cycle Management (RCM)
- End-to-end Reimbursement lifecycle
- Pre-authorization (Pre-auth) workflows
- Anatomy
- Physiology
- Pathology
- Surgery
- Gynaecology
- Certified Medical Coder
- Medical Charting
- Diagnostic Analysis
- Medical laws
- Ethical standards
- Hygiene safety
- Communication skills
- Claim review
- Team collaboration
- Internal auditing
- Audit coordination
Disclaimer
I hereby confirm that the information given is true to the best of my knowledge and belief.
Training
- National Homoeopathy Conferences: Decoding Homoeopathy, Oncology, Childcare, and Gynaecology hosted by KFH.
- Clinical Seminars: Attended sessions on Diseases of the Gastrointestinal Tract.
- Community Service: Participated in multiple flood relief medical camps with the IHMA Chennai chapter.
Core Competencies
eClaims Processing, Medical Claims Adjudication, Revenue Cycle Management (RCM), End-to-end Reimbursement lifecycle, Pre-authorization (Pre-auth) workflows, Anatomy, Physiology, Pathology, Surgery, Gynaecology, Certified Medical Coder, Medical Charting, Diagnostic Analysis, Thorough knowledge of medical laws, ethical standards, and hygiene safety., Skilled at interacting with patients and making them feel comfortable; fluent in Tamil, English, and Spoken Hindi (Level 6).
Languages
English
Beginner
A1
Tamil
Beginner
A1
Hindi
Beginner
A1
Timeline
Medical Claims Analyst (eClaims & Reimbursement))
Sutherland Healthcare
12.2021 - Current
Certified Medical Coder
Yogam BPO
Medical Trainee
JV Hospital, Kodambakkam, Chennai
Intermediate -
SRV EXCEL H.S.S.
High School -
ST. ANDREW'S H.S.S.
B.H.M.S. - Anatomy, Pathology, Forensic Medicine, Surgery, and Practice of Medicine
Sri Sairam Homoeopathic Medical College and Research Centre