Suresh P

Working on Tools – HRP, Citrix – Aerial, Pulse, IBX Medical policy Viewer, NPI, Onehub, SDS

Processing and resolving both UB04 and HCFA (CMS1500) claims, Adjustment and void according to established guide lines resulting in accuracy rate. Analyzing the member and provider information with the tool based on data given in the medical Image (UB, HCFA). Gained hands-on experience with Local and Supplier invoice inquiries. Validating the triggers like duplicate, Authorization, cob, manual split, pricing and subscriber not found and provider not found. Reviewing and resolving diagnosis codes, medical supplies, medical transportation, procedure codes and medical device claims. Supplier invoice : Investigated and resolved provider inquiries within established turnaround times. Onehub - Working on the tickets which is received by on-shore client side based on the request to reprocess the claims.

• Evaluated pre-authorization requests for medical services and procedures to ensure compliance with guidelines.
• Maintained accurate records of authorizations in electronic systems.
• Addressed patient case inquiries to clarify operational workflows in products and enhance customer understanding.
• Analyzed customer data to pinpoint improvement opportunities in accounts receivable process.

• Utilized Citrix tools for efficient software deployment.
• Processed adjudication claims, determining payment approval or denial.
• Handled authorization for COB (coinsurance, copayment, and deductible) duplicate claims.
• Priorities claim will be completed on time which assigned claims.
• Managed special project for zip code verifications, tracking high-dollar claims daily.

• Managed freight forwarding, last-mile delivery, scheduling for pickups/deliveries, and address correction to optimize transportation processes.
• Oversaw digital mailroom operations, document lifecycle management, and customs paperwork processing (invoices, packing slips) to ensure compliance and accuracy.