Priyadharshini K

• Conducted randomized audits to evaluate team performance, identifying trends and root causes to enhance productivity and accuracy.
• Led weekly team and one-on-one coaching sessions, leveraging audit insights to reduce error rates through targeted feedback.
• Developed and maintained training materials to uphold data integrity and operational consistency.
• Ensured process quality and reduced inventory backlog by providing ongoing technical support.
• Handled end-to-end adjudication of complex claim types including duplicate submission, cost shares, prior authorizations, eligibility- related claims, Host claims (pricing, benefits, Coordination of benefits(COB), entry claims).
• Consistently processed 800+ claims and audited over 500+ claims monthly with 98% accuracy, ensuring adherence to payer guidelines and maintaining high- quality standards.
• Adept at driving continuous improvement through quality assurance, root cause analysis and team mentoring.
• Implemented corrective action plans based on audit findings to minimize recurring errors and improve overall process efficiency.
• Collaborated with cross-functional teams (Operations, Training, and Quality) to standardize workflows and enhance claim accuracy.
• Developed quality dashboards and performance reports to track error trends, productivity metrics, and compliance indicators for leadership review.

• Job Description: Revenue Cycle Management in Healthcare
• Related to US based healthcare in Charges related function for Provider side transactions.
• Core description about the process is based on the charge posting in the billing software and dealing with CPT and Dx code procedures and processing for the payment with interaction to the customers.
• Billing software: Perspective content 1&3 and MDIV.
• Roles and responsibility:
• As an Associate my primary responsibility is to post charges for each patient correctly as per the PHI details provided by the client and processing the account and moving to the payment without any delay or mislead within the given time frame.
• I have been actively participating in all the training sessions provided related to my process and even got cross trained in Temp error and Denial claims (To analyze the reason for the denial).
• Initially joined as an associate in this process and internally got promoted to acting SME(Subject Matter Expert) after 6 months from joining because of my better process knowledge and quick learning skills.Now waiting for on paper SME posting.
• As an SME my primary job is to manage the team productivity, Quality check and fully on subject matter clarifications and also direct interaction with the client related to any process updates.
• As per the client expectation we should maintain 97 percent of quality for each account we process and will provide audit feedback to the team weekly basis based on the internal and external quality score.
• While working as an SME I got the opportunity to expand my learning in the Sub Function activities like Indexing and Missing Accession tracking for the clients I am handing.
• Major improvement got to handle a set of 20 team members and I was interested in learning new processes as well to upgrade my

● Accounting the firm, individuals, LLP and company’s financial

statements. Filling indirect taxes, Tax Audit and making paper

works for all the filling purposes.

● All Receipts & Payment entries, Bank entries, and Bank

Reconciliation. Prepared Audit report, Annual reports for filing

GST returns.

● Got certified for the one year Internship program which helped me

more knowledge about all the parts of accounts and the real-time

working experience.

● This training has helped me to work with different persons and

also learnt to work under a team.

● Verifying Income tax return filed and registration for directors in

MCA portal.

● Also performed Outdoor audits from the client office for the

annual audit by verifying with the invoices and the tally entries.

● Reconciliation of GSTR 1 & GSTR 3B for GST audit purpose.