PRANEESH YADAV
Hyderabad
Summary
Quality Expert with 5 years of experience in claims auditing, accounts receivable follow-up, and denial management within the US healthcare sector. Proven track record in implementing and monitoring quality control systems, enhancing operational efficiency. Strong analytical skills and attention to detail contribute to effective troubleshooting of complex processes. Demonstrated ability to drive significant improvements in quality outcomes.
Overview
5
5
years of professional experience
Work History
Quality Expert
Inventurus Knowledge Solutions
11.2024 - Current
- Conducting audits to identify non-compliance and areas for improvement
- Performing root cause analysis and implementing corrective actions.
- Conduct regular quality meeting and provide feedback and development opportunities to team members
- Creating and maintaining documentation of quality processes and Collaborating with cross-functional teams to resolve quality issues.
- Working experience in NextGen EPM.
Claims Specialist
Optum Global Solutions
04.2021 - 10.2024
- Strong knowledge on denial management and AR follow-up.
- Responsible for sending corrected claims to the insurance companies..
- Handle escalated and complex customer issues, helping to provide resolution and settlement of account..
- Responsible for calling insurance companies (in US) on behalf of doctors/physicians and follow up outstanding Accounts Receivable.
Revenue Cycle Officer
Inventurus Knowledge Solutions
05.2020 - 04.2021
- Reviews and analyze outstanding insurance claims, to get paid.
- Has to work on Appeals denials.
- Responsible for sending Medical records to the insurance companies.
Education
B.COM - Honours
Aurora Degree and PG College
Hyderabad05.2018
Skills
- Claims Processing
- Quality auditing
- Root cause analysis
- Denial management
- Quality metrics
- Problem Solving
- Communication
- Quick Learner
Accomplishments
- Most Improved Performer: Achieved most improved performer for consistent improvement shown in training.
- Venus Star Award: Achieved Venus Star Award for 4 consecutive months for contributing towards the process by providing best overall performance.
Languages
- English
- Telugu
- Hindi
Passions
- Cycling and Workout: Enjoys cycling and engages in physical fitness through regular workouts.
- Chess: A keen chess player who enjoys strategic games.
Timeline
Quality Expert
Inventurus Knowledge Solutions
11.2024 - Current
Claims Specialist
Optum Global Solutions
04.2021 - 10.2024
Revenue Cycle Officer
Inventurus Knowledge Solutions
05.2020 - 04.2021
B.COM - Honours
Aurora Degree and PG College
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