Summary
Overview
Work History
Education
Skills
Certification
Affiliations
Languages
Timeline
Generic

Shiva Kumar Vadlamudi

Hyderabad

Summary

Epic Bridges Consultant and experienced Healthcare IT professional with a demonstrated history of working in Revenue Cycle Management for 8 years. Completed a Master’s in Business Administration (HR & Marketing). Detail-oriented and customer-focused billing professional with extensive experience in claim processing, handling charge-related issues, managing clearinghouse operations, and scrubbing CMS-1500 and UB-04 claims. Possesses thorough knowledge of EDI (Electronic Data Interchange), claim denials and rejections, appeals, patient financial services, medical coding (ICD-10 CM, CPT, HCPCS), client documentation, and HIPAA compliance.

Overview

9
9
years of professional experience
1
1
Certification

Work History

Epic Bridges Consultant

Deloitte
05.2022 - Current

Senior Analyst

R1 RCM
08.2020 - 05.2022
  • Maintained the highest levels of accuracy and patient confidentiality. Worked on critical/special projects to reduce A/R management days and claim denials, optimizing the clean claim process by 43%. Researched and resolved incorrect payments, EOB rejections, and other issues with outstanding accounts.
  • Efficiently and accurately processed claims for both hospital billing and professional billing for various clients. Reviewed billing edits and provided insurance parties with corrected information, which reduced turnaround time by 53% and decreased the number of denials due to missing provider information.
  • Commended for proficiency in multitasking while managing administrative work, ensuring top-level patient care and support by acting as a liaison between business departments, billers, and third-party payers to resolve billing and reimbursement issues.
  • Developed training plans and provided necessary training to new hires, offering constructive feedback as needed.

Senior Revenue Cycle Specialist

Cerner Corporation
10.2019 - 08.2020
  • Proactively identified pre-billing edits, rejections, and invalids on time. Prepared and submitted reports, collaborating with leadership to improve the quality of task delivery.
  • Handled monthly statements, payment plans, and provided collection support. Followed up promptly on all claims to ensure no submission dates were missed.
  • Expert in reviewing remittance codes from EOBs/ERAs, completing appeals, filing and submitting claims, and posting charges, payments, and adjustments, which resulted in a 52% reduction in account write-offs for leading payers within 12 months.
  • Meticulously tracked and resolved underpayments daily, documenting workflows and task delivery details for team use and sharing with clients.

Executive-AR

Omega Healthcare
08.2018 - 08.2019
  • Analyze claim denials for coding errors or payer policy updates and make necessary corrections.
  • Update patient accounts with the correct insurance and/or demographic information.
  • Review provider coding or documentation that may need to be updated to release for billing.
  • Generate appeals or reconsideration forms for denied claims using web portals or payer-specific forms.
  • Help develop claim edits to increase cash flow and create clean claims.
  • Monitor and review open accounts receivable to identify adjustments, refunds, and payment breakdown amounts.

Junior Medical Coder

XL Health
04.2017 - 02.2018
  • Increased coding accuracy by diligently reviewing medical documentation and applying appropriate codes.
  • Reviewed patient medical records to accurately identify and assign ICD-10-CM codes for both inpatient and outpatient charts.
  • Ensured correct mapping of codes to appropriate HCC categories.
  • Utilized coding software and EHR systems efficiently.
  • Ensured accurate data entry and management within coding systems.

AR Associate

IKS Health
07.2015 - 12.2016
  • Resolved pre-billing edits, rejections, and invalids that affect payment, ensuring effective payment generation.
  • Processed electronic billing to post insurance payments and conducted calls to patients to collect outstanding balances and issue refunds as necessary.
  • Performed accounts receivable responsibilities.
  • Reviewed medical records and patients' medical and clinical history through EMR, and created appeal packages to fax or email to US health insurance companies.
  • Updated patient accounts with correct insurance and demographic information.
  • Monitoring and reviewing open accounts receivable to identify adjustments, refunds, and payment breakdown amounts.

Education

MBA - HR & Marketing

Siddhartha Institute of Science & Technology
Hyderabad, India
05-2015

Bachelor of Science - Mathematics, Electronics & Computer Science

Avanti Degree College
Hyderabad, India
05-2013

Intermediate - Mathematics, Physics & Chemistry

Guntur Vikas Junior College
Hyderabad, India
05-2008

SSC -

Grace Mission High School
Hyderabad, India
05-2006

Skills

  • Team Leadership & Development
  • Client Relationships
  • Client Engagement
  • Project Management
  • Change Management
  • Project Implementation
  • Process Optimization
  • Content management system
  • Go-Live Support
  • Revenue Cycle Management

Certification

  • [Bridges Interfaces EDI 101] [Epic] [2022 SEP]
  • [CPC-A] [AAPC] [2016 FEB]

Affiliations

  • Spot Award
  • Best Employee of the Month

Languages

English
Upper intermediate (B2)

Timeline

Epic Bridges Consultant

Deloitte
05.2022 - Current

Senior Analyst

R1 RCM
08.2020 - 05.2022

Senior Revenue Cycle Specialist

Cerner Corporation
10.2019 - 08.2020

Executive-AR

Omega Healthcare
08.2018 - 08.2019

Junior Medical Coder

XL Health
04.2017 - 02.2018

AR Associate

IKS Health
07.2015 - 12.2016

MBA - HR & Marketing

Siddhartha Institute of Science & Technology

Bachelor of Science - Mathematics, Electronics & Computer Science

Avanti Degree College

Intermediate - Mathematics, Physics & Chemistry

Guntur Vikas Junior College

SSC -

Grace Mission High School

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Shiva Kumar Vadlamudi