Saraswathy Rajkumar

• Provider Data Management – Project (Molina)-2024
  • Currently working under PDM in QNXT application
  • Enrolling, adding and updating provider details.
  Currently doing as a Quality Analyst.
  Preparing daily status reports, weekly, and monthly status reports and reporting to the higher management.
  Application Used:
  • QNXT
  • Claim Workflow
  • Claim Viewer
  • NPPES
  • Provider Trust
  • Tax port
  • BI Power Tool
• Provider Data Management – Project (Cigna)- 2023
• We manage provider data in the Citrix platform, handling full enrollment, maintenance, and termination. Upon receiving requests from the PDQ team in OnBase, we validate providers using NPI in QNXT, affiliate them to required groups and service locations, and update contract rates according to group agreements. We ensure all information is accurate and complete, adding memos and closing requests as needed. Weekly meetings with clients review progress, address defects, and discuss workflow. If termination requests are received, we entirely terminate providers, uncredentialed, and inactive them.

• Client working for Highmark.
• REIMBURSEMENT SPECIALIST: Experienced in managing reimbursement processes, including handling of reimbursements, claims, and inquiries.
  Duties and Responsibilities: Receive, review, and process reimbursement requests for clients.
  Review and verify all documentation to ensure accuracy and completeness.
  Calculate and verify reimbursement amounts.
  Maintain accurate and complete records of all reimbursements. Update and maintain reimbursement databases.

Application used:

• PRFA - Provider Reimbursement
• Facility pricing.
• Provider Profile,
• High-test