Summary
Overview
Work History
Education
Skills
Personal Information
Timeline
Generic

Shirisha Gandamala

Secunderabad

Summary

· 11 years of work experience in healthcare industry in provider verification, claims adjudication and Enrollment and Billing.

· Expertise in eligibility determination, claims adjudication, denial handling, high dollar claims

and claims adjustment.

· Have trained and provided support to different batches of new joiners on US Healthcare concepts.

Overview

5
5
years of professional experience

Work History

Team Lead

Carelon Global Solutions
04.2021
  • Currently handling a team of 22 associates of two different LOB’s
  • Handling more than 14 queues with complete cross utilization of each associate in multiple queues
  • Allocating daily jobs and workloads
  • Prioritizing important tasks and ensuring they get done first
  • Maintaining Team Attendance tracker, Time tracker & Leave tracker
  • Managing Team Performance and progress
  • Giving prompt and accurate information on individual Associate Performance to higher management
  • Maintaining operations rigor around daily huddles, visual management, knowledge management, cross training etc
  • Driving the team to achieve process Service Level Agreements / metrics i.e
  • Productivity and quality targets within the established timelines
  • Capacity Planning
  • Assess and forecast staffing requirements based on client communication and incoming volume
  • Ensuring the compliance controls are met and documented process guidelines are followed
  • Allocating client requests, complaints, and concerns on a priority basis
  • Ensuring optimum resource utilization through cross training initiatives and buffer management
  • Guiding and mentoring team members
  • Conducting team building activities to enhance motivation among the team members
  • Conducting Process knowledge test & reviewing scores, providing feedback and recommend refresher trainings whenever necessary
  • Updating the reports to the manager on performance, status, and any escalations
  • Motivating team to achieve desired Quality and Production targets
  • Development and maintenance of Standard Operating Procedures (SOP) and other documentation to ensure uniformity across teams and processes
  • Engaging with other processes to understand and implement best practices
  • Delivering the Report on monthly Project review to the Reporting Manager.

Senior Process Associate

Cognizant Technology Solutions
Hyderabad
09.2013 - 03.2019
  • Responsible for the accurate processing and auto adjudication of claims
  • Processing includes payments, denials, vendor returns
  • Analyze the details of each claim to determine if it should be paid or denied
  • Assigning the work to the team and handling the team in the absence of lead
  • Helping the team in understanding, interpreting& make decisions related to claims clarification
  • Responsible for internal audit of claims processed by associates
  • Mentor and train new hires on the floor so that they are productive in shortest possible time
  • Conduct weekly assessments to monitor and understand the growth and knowledge of new hires
  • Consolidation daily inventory, production and quality reports
  • Follow-up on claims for services rendered to patients by the providers such as hospitals, physicians, and labs
  • Insurance verification, checking claim status from websites and through calling
  • Perform follow-up services to ensure that all unpaid and selective denied claims are paid
  • To ensure that clients receive reimbursement for services they have provided to patients in the most efficient, regulatory complaint manner possible
  • Provide payers with accurate, timely information through negotiation-oriented follow-up efforts
  • Completing the mandatory trainings for self as identified in the training plan for the project
  • Worked on both professional HCFA 1500 and Institutional UB92 claim forms.

Education

B. Pharmacy -

Gokaraju Rangaraju College of Pharmacy
01.2013

Skills

Capability to learn new concepts and latest technologies

Willingness to take up additional responsibility

Knowledge of the waterfall model and agile frameworks

MS-Office

Analytical skills

Flexibility

Leadership

Expertise and Achievements:

Experience in Team/ People management, Client Management including Escalations and day-to- day deliverables like scheduling, production planning, and quality assurance

Strong oral and written communication skills

AES score greater than 95% and 0 attrition continuously for 2 years

Experience in resource hiring

Stakeholder management

Best performer month on month and quarterly basis

Completed WIL Program

Team player with initiative in organizational activities and a core committee member of Melange, focusing on culture and fun

Personal Information

  • Date of Birth: 11/17/1991
  • Marital Status: Married

Timeline

Team Lead

Carelon Global Solutions
04.2021

Senior Process Associate

Cognizant Technology Solutions
09.2013 - 03.2019

B. Pharmacy -

Gokaraju Rangaraju College of Pharmacy

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Shirisha Gandamala