SRUTHI SUBASH

Handling Complaints, appeals and Grievances of US HealthCare. Review, research, investigate, and analyze formal appeal cases. Also, review administrative cases and authorize resolution where required.

• Working as Acting Team Lead and Subject Matter Expert, I provide team support, quality audits, training, review, research, investigating, and analyzing formal appeal cases.
• Handling a team strength of 20 people. Conducting daily huddles to appreciate the team for their achievements and team contributions.
• Managed appeals and grievencs in accordance with NSA (No surprise Act) guidelines
• Inventory allocation to the entire team on a TAT basis.
• Handling non-clinical appeals/claims, payer background with regard to copay, coinsurance, and deductible.
• Interacts with co-workers and supervisors to audit and troubleshoot to meet client needs in a timely manner.
• Develops and implements procedures for the associates to meet quality and targets within TAT.
• Conducting training sessions for the analysts regarding new updates to the process.
• Assist the manager in planning and implementing strategies in the process.
• Preparing and maintaining SLA metrics and trackers. Sharing team production and quality with the team and manager daily.
• Composing clear and well-organized emails to communicate with clients in a timely manner.
• Supervise and motivate staff to perform their best in the daily huddles, and check in with them to see whether they are facing any issues.
• Completing tasks assigned by the manager accurately and efficiently.
• Validating clinical returns and raising rebuttals.
• Raising an intake request to update authorization.
• Analyzes the root cause of processing problems and keeps the team and manager informed of the issues and its solutions. Share the RCA and CAPA data with them as well.
• Prepare PKT for the team members and coaches, as well as less experienced staff, in learning procedures and insurance knowledge.

• Handling complaints, grievances, and appeals of providers for Aetna Health Insurance Company.
• Handling New York Fully Insured appeals.
• Accountable for meeting daily production targets by maintaining the TAT.
• Handling client escalations before turnaround time.