Rethis Paramasivan

• Identify the root cause of payment denials or rejections and work with the billing and coding teams to resolve issues
• Oversee the denial management process to ensure timely resolution and re-submission of claims when necessary
• Track and analyze trends in denials to identify areas for process improvement
• Document any inconsistencies, errors, or issues found during the quality checks and suggest corrective actions
• Identify opportunities to streamline and improve AR processes to reduce errors and enhance overall efficiency
• Provide feedback and recommendations to management regarding process improvements, training needs, or system enhancements

• Ensure that medical bills are accurate, complete, and compliant with all relevant regulations, such as the Health Insurance Portability and Accountability Act (HIPAA) and Current Procedural Terminology (CPT) guidelines
• Conduct thorough reviews and audits of medical claims, invoices, and coding to identify errors, discrepancies
• Maintain detailed records of audits, reviews, and corrective actions taken to demonstrate compliance with regulatory requirements
• Provide training and guidance to billing staff to improve accuracy and compliance
• Providing regular feedback to management and suggest improvements to review and approve quality-related documentation, such as standard operating procedures (SOPs)
• Conduct internal assessment to assess compliance with quality standards and identify non-conformities

Denial Management

• Monitor the status of submitted claims and follow up with insurance companies to track the progress of claims processing
• Address any issues or denials promptly and resubmit corrected claims if necessary
• Utilizing online portals and emails for online dispute
• Keeping track of denied claims and following up until gets paid

Front End Billing

• Prepare and submit appeals for denied claims, providing additional documentation or justification as needed to secure reimbursement
• Prepare and submit insurance claims to various healthcare payers, such as private insurance companies, Medicare, Medicaid, and government programs
• Utilize electronic health record systems to access patient information, update records, and manage billing processes efficiently
• If any Rejection occurs, then need to analyze and fix the claim for possible payment by fixing the rejection on behalf of the provider

• Conducted insurance verification and pre-authorization processes to minimize claim denials and payment delays
• Implemented effective follow-up strategies, including phone calls and appeals, to resolve denied or underpaid claims and increase revenue recovery
• Maintained detailed documentation of all communication and actions taken regarding accounts
• Participated in team meetings to share insights, discuss challenges, and develop strategies for process improvement