Jeya Anandhi

• Verify patient eligibility, obtain prior authorizations, coding-related denials. Specialist of coding related denials like(CPT, Modifier, Dx, Units etc.,)
• Fixed the denials in the starting level – it helps to avoid frequent denials. Always updating myself on CMS guidelines and new protocols from insurances.
• Operational tracking of billing, past due balances, adjustments, refund, and payment information and related controls to ensure the accuracy and timeliness of related customer charges and transactions, to include analysis, investigation, and resolution of any variances.
• Analyze and research accounts to ensure that customer service level requirements are met or exceeded.
• Account reconciliation and collection, including debit and credit research; analysis of account balances.

• Coordinated team activities and delegated tasks to ensure efficient completion of projects.
• Monitored daily workflow to ensure adherence to established policies and procedures. Provided coaching and feedback on employee performance, encouraging professional development.
• Created training materials and conducted group trainings on new processes or procedures. Assigned projects and distributed tasks to team members as per area of expertise.
• Stay updated on industry trends and changes in insurance regulations.
• Maintained open lines of communication with senior management, reporting team progress and challenges. Completed daily quality assurance duties to provide feedback for improvements.
• Managed conflict resolution within the team to maintain a positive work environment.

• Reviews and resolves accounts assigned via work lists daily, as directed by management. Focus on working complex denials across multiple payers and/or regions. Conducts account history research as required, including navigating patient encounters and charts, researching charge and payment histories, determining historic account and claim status changes, and researching the payer remittance advice.
• Conducts follow-up research on claims to review contract discrepancies and account balances. This may include attaching documentation, amending coverage, patient, encounter, provider, and facility data, gathering additional information requests, and resubmitting corrected claims to ensure accurate and timely claim adjudication. Review explanation of benefits (EOB) or, if not present, call the Payor to obtain claims status for denied claims
• Defends and appeals denied claims, including researching underlying root cause, collecting required information or documents, adjusting the account as necessary, resubmitting claims, and all appropriate follow-up activities thereafter to ensure adjudication of the claim. Must also be comfortable communicating denial, root cause, and resolution to leadership as needed.
• Maintains an up-to-date knowledge of department policies and procedures; responsible for external changes made based on future state revisions to processes.
• Performs other duties as assigned by management, including, but not limited to, training new staff and projects given by management.

Associates - Level 2 (Denial Management)

• Identified and resolved problems through root cause analysis and research between 20 and 50 accounts per day, validated results, and performed quality assurance to assess accuracy of data.
• Knowledge of modifier denials, exactly know about the modifier description. It helps to get the payment in the initial period. Enter patient demographics, verify diagnosis codes.
• Analyze billing and claims for accuracy and completeness; submit claims to proper insurance carriers, and follow up on any issues. Followed up on denials and unpaid claims to ensure maximum cash flow and reimbursement.
• Applied knowledge of data modeling and statistical analysis to note trends and draw conclusions.

Associates Level - 1 (Payment Posting)

• Reconciled vendor statements and handled payment complaints or discrepancies.
• Posted all electronically available payer remits to appropriate accounts. Posted credit card payments electronically or manually, as needed.
• Precisely completed appropriate claims paperwork, documentation, and system entry.
• Developed and implemented performance improvement strategies and plans to promote continuous improvement.