Abhishek KS
Summary
Analytical professional with 6+ years of strong foundation in claims analysis and quality auditing. Cultivates relationships with clients by delivering outstanding service and addressing priority requests. Leverages adaptability and team collaboration to drive process improvements and support business objectives.
Overview
7
7
years of professional experience
Work History
Senior Process Executive - Data
Cognizant
11.2024 - Current
- Identify the root cause of claims denials and take corrective action to ensure resolution.
- Responsible for the accurate processing of medical and facility claims, including rework, and maintaining TAT (Turn-Around-Time) with quality and production per client SLA.
- Working in medical surgery or radiology, outpatient or inpatient, verify the complete membership details.
- Knowledge in RCM, payer, provider, and member enrolment.
- Processed medical claims for HCSC, ensuring accuracy and compliance with regulations.
- Strong process knowledge of applying deductibles, copays, coinsurance, out-of-pocket expenses, manual pricing, COB, policies and procedures, inpatient claims, and outpatient claims.
- Conducted high-dollar claims auditing to reduce high-dollar errors.
- Took on additional tasks to aid the team's success.
- Performing quality and duplicate checks for invoices greater than 50k USD.
- Responsible for escalating overdue invoices, billing, and following up with the internal Material Controller for quantity and price discrepancies.
- Handled different modules in the process, such as PPO, HMO, AT&T, and other dedicated accounts.
- Sound knowledge in understanding policies, healthcare terminology, and procedure workflows.
- Tools: Fecet, emulators, automation tool application, IBM Image Tool, macro running, VDI application from client, and Citrix User.
Senior Process Consultant
Sagility
08.2019 - 11.2024
- As a Claims Process Consultant in Medicare for over five years.
- As a Claim Process Consultant, after a medical claim is submitted, my duty is to determine the financial responsibility for the payment provider.
- Training new employees, helping them to understand the business routine, and monitoring their daily tasks during the initial period.
- I have 2 years of experience in quality auditing and compliance checks.
- Analyse QA trends, audit findings, and root cause analysis (RCA) to provide actionable insights and recommendations for process improvement.
- Conduct side-by-side evaluations and real-time monitoring of claim processing to assess accuracy, compliance, and efficiency against QA benchmarks.
- Analysed and examined insurance claims, applying comprehensive knowledge of insurance principles and policies.
- Consolidated aged reports on a daily and weekly basis for management.
- Tracked production, self-pends, and OT hours reports on a daily basis to cascade to management.
- Worked on BCBS, Medicare, Medicaid, Humana, and other insurances to track patient status and bill the insurances accordingly.
- Conducted process training for new joiners, clarifying doubts, validating and rectifying errors, and handling the team in the absence of the Team Manager.
Education
M.COM - Accounting
KSOU (Karnataka State Open University)
Bengaluru, KA01-2024
Bachelor of Commerce - Accounting
KLE's Nijalingappa College
01-2019
Department of Pre-University - Accounting
Surana Independent PU College
01-2016
SSLC -
St. Johns High school
01-2014
Skills
- Claims analysis
- Proficiency in Excel, Word, and related software
- Adaptability and flexibility
- Quality auditing
- Inventory management
- Team collaboration
- Root cause analysis
ACHIEVEMENTS
- Star of the Month
- Shining Star Award
- Client Appreciation
- Quality Award
Languages
English
Upper Intermediate
B2
Kannada
Proficient
C2
Tamil
Elementary
A2
Hobbies and Interests
- Cricket
- Travelling
- Gaming
- Movies & Series
Declaration
I do here by declare that the details given above are true to the best of my knowledge.
Timeline
Senior Process Executive - Data
Cognizant
11.2024 - Current
Senior Process Consultant
Sagility
08.2019 - 11.2024
M.COM - Accounting
KSOU (Karnataka State Open University)
Bachelor of Commerce - Accounting
KLE's Nijalingappa College
Department of Pre-University - Accounting
Surana Independent PU College
SSLC -
St. Johns High school