Prushna Kantha

• Worked for "Walmart" as a Senior Chat Support.

Responsibilities:

• Handle all Customer Complaints or Concerns professionally to maintain good customer relationship and ensure repeat customers.
• Maintain accuracy and customer satisfaction by sustaining current knowledge of store policies.
• Gave assistance to new hires by maintaining the productivity and Quality.

• Worked in “Optum Global Solutions” as a Quality Associate from May 2017 to May 2019.

Responsibilities:

• These processes include the review of claims, contracts and fee schedules to identify processing, procedural, systemic and billing errors and practices leading to claims over-payments.
• Perform complex claims analysis and audit activities to identify trend s, determine root causes internal divisions to ensure that recovery opportunities are appropriately identified, pursued and reported
• Auditing the processed claims and initiating Over-Payments if the claim was overpaid to the Provider.
• Reviewing Provider paper contracts to see whether the claim was processed correctly.

• Worked in “Sutherland Global Solutions” as a Specialist from November 2014 to December 2016.

Responsibilities:

• Responsibility was to pre-encounter the patients information.
• Calling multiple Insurance companies to check the coverage of the patient and work on Eligibility and Benefits.
• Worked on complete Referrals for the patients as per client based.
• Ensured HIPAA Guidelines.
• Worked on AR follow-up claim denials.

• Worked in “Apollo Health Street” as a Process Associate from 13 June 2011 to 2nd June 2013. 23 months of experience as "Process Associate" trained in Market Region (Medicare PPO) and (Medicare HMO).

Responsibilities:

• Updating Providers demo-graphical and contract information into the payer system depending upon the task originated.
• Assisting the client on various tasks and contacting them through emails for further information.
• Credentialing the provider information through NPI Registry and USPS.com
• Maintaining consistency in Quality and improving productivity regularly. Contract loading is the process which deals with uploading and updating all the information provided by the Physician (Qualified) during the time of Contract into Humana's database is to access through a portal and also for users to find his whereabouts. It also providers the details pertaining to his Claims and their status.