Murugan D
AR - RCM OPERATIONS SME
No 23, Health Emp Colony, Nainarmandapam, Pondicherry
Summary
ABOUT ME
Senior Client specialist experienced in directing activities of workgroups. Develops strategies, provides training, sets goals and obtains team feedback. Excellent interpersonal and communication skills. Big picture focus with excellence in communicating goals and vision to succeed. Problem solver, networker and consensus builder. Multitasking Team Leader well-known for executing successful, new initiatives. Creates dynamic and positive workplace culture to align with organizational mission and values. Trains new hires and mentors struggling workers to achieve overall team success. Organized Team Leader builds positive rapport, inspire trust and guide teams toward achievement of organizational goals. Strong facilitator adept at working cross-departmentally with co-management and top-level leadership. Excellent trainer and mentor.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Sr.Subject Matter Expert - End to End RCM
Access Healthcare PVT.Ltd
Chennai
03.2017 - 04.2024
- Assist with training for all new AR staff, serving as the SME for accounts receivable questions from staff
- Assists with obtaining educational materials for the AR staff
- Reviews medical records to determine if the services identified were medically necessary in accordance with the state policies and federal regulations
- Performs assigned additional project related responsibilities that are considered small to medium in nature
- Responsible for calling Insurance companies on behalf of doctors/physicians and follow up on outstanding Accounts Receivable
- To prioritize the pending claims for calling from the aging basket
- Should be able to convince the claims company payers for payment of their outstanding claims
- To check the appropriateness of the insurance information given by the patient if it is inadequate or unclear.
- To make a physical call by following the international norms and applicable rules for confidentiality and HIPAA compliance
- Review provider claims that have not been paid by insurance companies
- Post cash and write off the contractual adjustments accordingly while working on the accounts.
- Meetng daily/weekly and monthly targets set for an individual.
- In case the patient does not have sufficient insurance coverage for the medical procedure or if the patient is in any way not eligible for coverage, transfer the outstanding balance to the patient.
- Sound knowledge of U.S. Healthcare Domain methods for improvement on the same
- To coach team members. Identifies development areas and helps the individuals and the team to improve their performance and enhance their potential
- Ability to take supervisory calls
AR Process Executive
Indian Healthcare Solutions PVT.Ltd
Chennai
04.2015 - 03.2017
- Following up on unpaid medical claims
- Analyzing EOBs (Explanation of Benefits)
- Verifying patient information
- Resolving claim issues
- Maintaining accurate records
- Insurance Verification and Eligibility
- Claims Submission and Appeals Tracking
- Rejection and Denial Analysis
- Initiation of AR Calls
- Payment Follow-up
- Denial management
- Claim follow up
- Rejection claim
- Handling on physician billing and hospital billing claim.
Process Associate
L- Cube Innovative Solutions
Chennai
10.2013 - 04.2015
- Process billings to patients and third party reimbursement claims. Working denials Follow up on submitted claims status and unpaid claims initiate tracers.
- Submitting corrected claims and appeals if necessary. Knowledge of medical terminology ICD-9/CPT codes
- Clear Dr.office open problem within 24 hours.
- Follow up on claims greater than 30 days for assigned type. Knowledge of PPO HMO, Medicare, Medicaid and commercial insurance. Maintain thorough knowledge of patient information system and its processes as it pertains to Billing/Collections.
Education
Master Of Computer Applications - Computer And Information Sciences
SMVEC Engineering College
Pondicherry04.2010
Bachelor Of Science - Mathematics
Sri Aravindar Arts&Science College
PondicherrySkills
Knowledgeable in Physician Billing and Hospital billing
undefinedCertification
[PGDCA], [RV Infotech] - [6 months]
Timeline
Sr.Subject Matter Expert - End to End RCM
Access Healthcare PVT.Ltd
03.2017 - 04.2024
AR Process Executive
Indian Healthcare Solutions PVT.Ltd
04.2015 - 03.2017
Process Associate
L- Cube Innovative Solutions
10.2013 - 04.2015
[PGDCA], [RV Infotech] - [6 months]
05-2006
Master Of Computer Applications - Computer And Information Sciences
SMVEC Engineering College
Bachelor Of Science - Mathematics
Sri Aravindar Arts&Science College
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