Vaijayanthi Murugesan

• Managed two AR teams (20 members), optimising billing workflows and achieving the client expectation of 98% in terms of quality for consecutive months.
• Performance Monitoring, Feedback & Coaching: I used to perform cross audits on the accounts worked by the auditors to ensure the accuracy of their performance, Identified knowledge gaps and initiated targeted training sessions, while providing constructive feedback to improve performance.
• Data Analysis: Analyzing production & quality data to identify trends, patterns, and areas for improvement, and making recommendations for changes to enhance overall performance.
• Partnered with the software team to implement macros that automated the publishing of process audits for top trending errors, reducing manual effort.
• Managed the MBR deck (Quality dashboard, transfer and return data explaining account routing to the client and corresponding responses). Handled client quality data, feedback, and rebuttals, while actively participating in client calls and monthly business review meetings to ensure alignment with client expectations.
• Trend Identification & Resolution: Claims dnd due to non-compliance with coverage/program guidelines when billing anesthesia services for CRNA with QZ modifier. Claim incorrectly billed using QZ instead of the appropriate QX mod, which should be used when services are performed under the medical direction of a physician anesthesiologist. Recommended implementing system logic to automatically bill clms with QX mod for CRNA services performed under the medical direction of a physician anesthesiologist. CC were refiled to the payer & the denial recurrence was prevented through this system fix.
• Documentation and Reporting: Maintained accurate records of quality assessments, additional tasks, and performance metrics. Prepared detailed reports to communicate findings and recommendations to management.

• Ensure timely resolution of all team-related issues in line with defined SLAs and quality standards.
• Resolution Audits: Suggested team to perform End to End audits in order to reduce the ineffective touches and increase the revenue by eliminating the inappropriate follow ups.
• Identified the issue of ophthalmology specialty claims, which are getting denied as CO109, these claims should be submitted to different payer but initially Epic doesn't have necessary coverage configuration to allow Electronic submission. I reported this issue to client, following this client created a alternate coverage in Epic to correctly identify ophthalmology claims and ensure correct submission.
• Identified many self registered portals and shared across operations to reduce call time and boost production to meet client expectation.
• Encouraged the team to participate in IJP and guided them through the assessments.
• Took initiative on conducting root cause analysis using 5 Why analysis and produced action plan for every performance dip.
• Oversaw team attrition and shrinkage, implementing strategies that enhanced retention and availability.
• Collaborate with the Training & Development (TD) team to update Knowledge Base (KB) and SOPs, and conduct monthly assessments on critical process updates.
• Managed client communications, resolving emails and escalations in a timely manner.

Assigned work orders to team and conducted audits to ensure compliance.

Performs Call audit to check the call ethics & call quality

Conducted weekly and monthly assessments to align team performance with process updates.

Participated in quality calibration sessions with the client to ensure alignment on performance standards.

Providing the sample charts to the training team which helps in the process training and general RCM workflows based on process update.

Conducted account-specific assessments for bottom performers.

Assisted training team in qualifying new hires and guided OJT/ramp associates through their onboarding process.

• Oversaw appeal process within TFL to maintain regulatory compliance.
• Worked High dollor WQ's and priority claims.
• Facilitated team discussions on new process updates during weekly meetings.
• Assisted new employees in understanding RCM and process updates.