Praveen Cheraka

Credit Balance - Cape Cod Process.

• Investigate credit balances for insurance and patient accounts, and resolve overpayments.
• Accurately process refunds or reclassify payments after a thorough review of EOBs, ERAs, and payer rules.
• Communicate with insurance companies and internal billing teams for clarification or documentation.
• Reviewed credit balances, and coordinated with AR and refund teams to ensure timely resolution.
• Prepare daily and weekly reports of resolved and pending credit balances.
• Participated in internal quality checks and helped improve SOPs for credit workflows.
• Maintain compliance with HIPAA, CMS, and organizational policies for financial accuracy.
• Achieved a quality score of 98% or higher consistently in audits, and exceeded monthly productivity benchmarks.

Senior AR - Affinity Process.

• Responsible for following up with U.S. insurance companies to resolve denied or unpaid claims.
• Handled claim status inquiries, appeals, and ensured timely claim reprocessing.
• Maintained a daily productivity of over 50 claims and a call quality score of over 97%.
• Conducted outbound calls to insurance carriers to obtain claim status.
• Identified root causes of denials, and worked with internal teams to correct and resubmit claims.

Senior AR: Change Healthcare Process

• Experience in AR Denials and Rejections for the US Healthcare process.
• Making outbound calls to customers to collect on past-due invoices and provide customers with details about previous and current account activity.
• Weekly, bi-weekly, and monthly follow-ups with customers to collect past-due AR and resolve customer queries.
• Identified and resolved billing discrepancies for customers.
• Investigate and resolve customer queries.
• Processed refunds for unapplied cash on customer accounts.
• Resolved approximately 90% of the receivables and those that are 60 days past due.
• Executed collection efforts to reduce the bad debts percentage.
• Sending weekly and monthly reports to different customers, which helps to run the entire process metrics.
• Prepare and share case studies with team members to help them improve their knowledge and accuracy on no-contact and disputes.

• Worked as the audit administrator in the Third Party Audits team at Walgreens Health Care Process as a Senior Process Developer.
• Handled Medicaid insurance audits and handling one of the top remitter which need lot of
  manual intervention and great focus as it can lead to multimillion dollar ($) bad debt.
• The main focus of the role/work is to coordinate with various internal departments (client side) to gather the required information or documentation to dispute the errors or discrepancies that the insurance companies find on already paid claims as a result of their audit reviews.
• One of the key elements is to work with the pharmacy stores through calls and emails, guiding them to obtain the valid documents to dispute the discrepant claims.
• It requires great rigor to maintain an effective communication channel with the stores and insurance companies to address issues or clarifications required to dispute the discrepant claims to save the dollars at stake.
• I have been interacting with the client during the weekly update calls with my counterparts in Deerfield, IL. Providing updates on the remitters that I handle, and brainstorming to identify any opportunities to improve the current process.
• I have been responsible for training the newly joined folks in the process until their client certification is done.
• Handled multiple reporting activities involving internal reports for team members for their daily tasks, as well as external client reports, like high-dollar audit reports.
• Conducting daily team huddles and making sure the process updates are shared with the team, timely, and making sure the team is involved in the huddles and in the fun activities to make the team bonding stronger.
• I was selected as an HR Catalyst in the Walgreen account, and I feel it is a privilege to be able to learn something new and understand more about the company from a people management standpoint.

• Worked for Walgreens under HAR (Healthcare accounts receivables)
• Insurance Billing: Worked on all types of denials received from Insurance companies and resolving them in a best possible manner to get maximum
• Enrollment
• Collections and payment posting.
• Claims Adjudication
• Account Receivable (AR)