S. ALLEN NIRMAL RAJ
Chennai
Summary
To pursue a challenging career and be part of a progressive organization that gives scope to enhance my knowledge, skills and to reach the pinnacle in the computing and research field with sheer determination, dedication and hard work.
Overview
8
8
years of professional experience
Work History
Senior Associate
GUIDEHOUSE
12.2023 - Current
- 1.7 years of experience in GUIDEHOUSE as Senior Associate
Senior Client Partner
Access Healthcare
09.2021 - 11.2023
- 2 years of experience in Access Healthcare as Senior Client partner
Executive
Executive In Audit & Assurance
03.2019 - 02.2020
- 1 year experience as executive in audit & assurance
Associate
Zealous Services
02.2017 - 02.2019
- 2 years of experience As an Associate in Zealous Services (Semi-Voice)
Education
B.C.A. - Computer Application
MGC College Of Arts And Science
HSC -
Sacred Heart Hr Sec School
SSLC -
Sacred Heart Hr Sec School
Skills
- Denial Management: Specialized in handling Mother-Baby Clause denials and Pediatric claim denials and coding and auth denials
- AR Calling Expertise: Proficient in insurance follow-ups, appeals, and reprocessing claims under complex scenarios
- Medical Billing Knowledge: Familiar with CPT/DX compatibility, COB updates, and timely filing protocols
- Communication: Skilled in liaising with payers to resolve claim issues and ensure accurate reimbursements
- Special Projects: Collaborated with Medical Records, Appeals, and Coding teams to streamline documentation, reduce denial rates, and improve claim accuracy
- Coding Coordination: Collaborated with coders on a special project called EEC to correct CPT/DX mismatches, address modifier issues, and ensure compliance with payer guidelines
- Physician Billing Expertise: Proficient in end-to-end billing for physician services, including charge entry, claim submission, and payment posting
- Quality Focus: Familiar with QA workflows including call monitoring, documentation review, and accuracy checks
- Knowledgeable in DPU (Defects Per Unit) and DPO (Defects Per Opportunity) metrics for monitoring process performance and error rates
- 7 qc tools-Check Sheet, Cause and Effect Diagram (also known as Fishbone or Ishikawa diagram), Histogram, Pareto Chart, Scatter Diagram, Control Chart, and Stratification
- Proficient with software knowledge in Athena, Next-Gen, GPMS
Languages
English, Tamil, Hindi
Characteristics
- Ability to adopt new technical things quickly.
- Can extend good relations with all kinds of people.
- Team work management
- Flexibility
Hobbies and Interests
Playing cricket, pc gaming, volley ball
Responsibilities
- Denial management (Athena)
- Follow up on the insurance company behalf of the Provider or the facility.
- Ensured HIPAA compliance.
- Utilized strong assessment skills to determine medical necessity for the post payment denials.
- Identified and resolved system and account issues.
- Cooperated with Blue cross blue shield (Medicaid), Medicare and well also other private insurance providers to resolve billing issues.
- Observe strict confidentiality and safeguard all patient-related information
Disclaimer
I hereby solemnly declare that the above mentioned details are correct to my knowledge and my rich experience would help me in justifying my aspiration to do better in your organization. Date: Place: Chennai. (S.ALLEN NIRMAL RAJ)
Timeline
Senior Associate
GUIDEHOUSE
12.2023 - Current
Senior Client Partner
Access Healthcare
09.2021 - 11.2023
Executive
Executive In Audit & Assurance
03.2019 - 02.2020
Associate
Zealous Services
02.2017 - 02.2019
B.C.A. - Computer Application
MGC College Of Arts And Science
HSC -
Sacred Heart Hr Sec School
SSLC -
Sacred Heart Hr Sec School