Venkatesan Govindasamy

• Verified patient demographics and charge information against documents before submitting claims to insurance.
• Checked insurance coverage benefits through online portal services to ensure accuracy.
• Identified denials and implemented timely actions to secure payments from payers.
• Analyzed and resolved rejected claims within turnaround time constraints.
• Posted payments according to EOB, EFT, COB, and ERA guidelines.
• Sought clarification from coding team to prevent diagnosis code errors.
• Prepared weekly reports detailing denied claims and clear claim statuses.
• Participated in weekly calls with physicians to discuss quality improvements and updates to SOPs.

Experience Authorization.

• Managed end-to-end prior authorization processes for diverse payers, including UHC, Availity, and VA, leveraging four years of hands-on experience.
• Verified, for each billed service, the necessity of prior authorization by systematically reviewing payer portals and guidelines.
• Determined service-based requirements (inpatient, outpatient, specialty) to identify whether an Auth ID was necessary, ensuring compliance with payer policy.
• Effectively utilized payer/provider portals to check eligibility, benefits, and submit prior authorization requests with the required clinical documentation.
• Tracked the status of submitted authorizations, followed up on pending or denied requests, and proactively resolved issues to secure approvals prior to billing.
• Maintained accurate records of authorization numbers and their status in the billing system to minimize claim denials due to missing or expired authorizations.
• Collaborated with physicians, clinical staff, and patients to gather information for submissions, and communicate authorization status or documentation needs.
• Demonstrated expertise in payer rules and efficient revenue cycle management by ensuring timely and accurate prior authorization for all billable services.

• Responsible for allocation of work orders to team members as per inventory.
• Guiding and giving training for new joiners with training materials.
• Analyzing CAQH form and provider document to enroll the providers in provider database (CPD/Apex).
• Attending weekly client calls and discussing about inventory and new updates.
• Contacting Quality meeting on daily basis to ensure team quality.