Nanjappan D
Coimbatore
Summary
Trained experience in health care sector ranging from administrative to financial responsibility, motivated, energetic, and reliable under pressure. Established strong problem resolution skills and ability to function as a team player as well as Individual to achieve objectives.
Overview
8
8
years of professional experience
2
2
Certifications
Work History
Senior Quality Reviewer - US Heathcare Claims
Cognizant
12.2023 - Current
- Performed quality control review to ensure team performance is 100% for the month.
- Participated in audits and validated processes, contributing to the successful maintenance of a project.
- Analyzed inquiry to identify common errors, leading to the creation of targeted training that enhanced overall team accuracy.
- Provide detailed feedback and coaching to the team based on audit results, contributing to the improvement of the team's accuracy level.
- Participating in a calibration call with clients regarding updates and clarifications to be cascaded with the teams.
Production Specialist - US Heathcare Claims
WIPRO BPS
12.2021 - 07.2023
- I joined the company as a production specialist associate and was promoted to Sr. Associate
- Undergo pre-process training on revenue cycle management.
- Review claim information in both electronic and paper claims.
- Determine and understand the coverage provided under a member plan.
- Reviewed and ensured that there’s no missing or incomplete information.
- Adjudicated Medicare, Medicaid, dental, and mental health claims.
- Handling CMS-1500 and UB-04 claim forms.
- Process the claims within the performance guidelines of the department, including quality and timeline.
- Awarded in R&R as Best Performer for 'Eagle Eyes' every month.
- Recognized as a top performer for achieving incentive criteria.
Senior Client Partner - US Heathcare
Access Healthcare PVT LTD
11.2017 - 12.2021
- Accurately posted daily insurance and patient payments (cash, check, credit card, EFT) using specific medical billing software.
- Reconciled Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs), applying appropriate denial/adjustment codes.
- Managed accounts receivable (A/R) and accounts payable, handling refunds, credit balances, and overpayments.
Education
Bachelor of Commerce - Information Technology
VLB Janakiammal College of Arts And Science
Coimbatore, Tamil Nadu06-2016
Skills
- Knowledge in using Scribe to format different kinds of letters, which are responses to providers and members
- Handling the emulator to process claims and inquiries knowledge in using PRAP, procedure flow, Blue Squared script, Claim GUI, premier pricing, RTB, and Benefit Navigator to retrieve different kinds of payment denial, provider, and member data which we needed to process inquiries and claims
- Proficiency in identifying the EOB, EOMB, MD determination, CMS 1500, and UB 04 review form to process queries
- RFCR to recoup payment in a different method and for a different amount, like RFCR 1510, 1527, and 1529
- Work with different states like Illinois, Oklahoma, and Texas
Awards
- Awarded in R&R as Best performer for 'Eagle Eyes' in every month.
- Recognized as Top Performer for achieving incentives criteria.
Languages
- English
- Tamil
Certification
ICD-10-CM MEDICAL CODEING CERTIFIED
(RESOLVE MEDICAL CODING INSTITUTION)
(RESOLVE MEDICAL CODING INSTITUTION)
Timeline
Senior Quality Reviewer - US Heathcare Claims
Cognizant
12.2023 - Current
Production Specialist - US Heathcare Claims
WIPRO BPS
12.2021 - 07.2023
Senior Client Partner - US Heathcare
Access Healthcare PVT LTD
11.2017 - 12.2021
Bachelor of Commerce - Information Technology
VLB Janakiammal College of Arts And Science