Vijay Kumar G. R.
Bangalore
Summary
Dynamic and detail-oriented Sr. Executive in Medical Billing with extensive experience at Optimize RCM Pvt. Ltd. Proven track record in insurance verification and claims validation, leveraging strong analytical skills and computer proficiency. Committed to delivering high-quality results and enhancing operational efficiency in fast-paced environments.
Overview
26
26
years of professional experience
Work History
Sr. Executive - Medical Billing
Optimize RCM Pvt. Ltd
07.2024 - 05.2026
Sr. Executive - Medical Billing
Tharworx Pvt. Ltd
08.2020 - 06.2024
- Ensured accurate records by correcting and capturing patient demographic and insurance information.
- Utilized auto Zoll application and Availity to verify insurance eligibility, providing detailed comments during account closure.
Senior Process Associate - Billing
Advantedge Health Solutions Pvt. Ltd.
02.2018 - 08.2019
- Processing Anesthesia Professional Charges.
- Processing Pathology Professional Charges.
- Worked on VM Software.
Senior Quality Analyst – Billing
Logix Health Solutions Pvt. Ltd.
05.2014 - 07.2017
- Professional Charge Entry: We are processing Professional Charges (Flow Charge Entry) for the providers in US and we are Responsible for Cross verifying Patient Insurances, like, Medicare, Medicaid, WC, MVA and Commercial Insurances and bill the Insurances which are in Active Status.
- We are also responsible for Claims Validations which are rejected from Insurance Company such as, Invalid Cert# Missing, Referring Provider Missing for Medicare, Invalid data entered for Patient Subscriber, etc.
- Quality check for newcomers and giving training to them.
- Worked on Allscripts Software.
- Facility Charge Entry: In this, We are receiving Charge Reports directly from Hospitals and We are manually entering the CDM Charges, Diagnosis Codes, Procedure Codes, E-Codes. Also request clarifications to clients for some Edit Codes in the Process through Client Guidelines. In Facility Charges, We are working on Hospital client Software and sending completed work directly to Hospitals within TAT given by Hospital Client with 100% quality.
Process Associate
Cross domain Solutions Pvt. Ltd
08.2012 - 12.2013
- Responsible for capturing patient demographic information (demo & charges) and also responsible for Patient’s Insurance Verification (primary, secondary, Tertiary insurance) through Eligibility Criteria by web search.
- Worked on Cerner software.
Sr. Associate
EXL Pvt. Ltd
10.2009 - 05.2012
- Responsible for processing the cheques, ATM envelopes, and non-negotiable instruments through Canadian Bank Guidelines. Also responsible for identifying Fraud cheques and verifying signatures on cheques and meeting Client Quality Standards in SLA timings.
- Previously known as Outsource Partners International Pvt. Ltd.(OPI)
Process Associate
Omega Healthcare
10.2007 - 10.2009
- Worked in Charge Entry and Insurance Verification Process.
04.2000 - 09.2007
- Involved in Family Business in Home town- Sagar, Shimoga Dist.
Education
Bachelor of Business Management -
Mangalore University
Diploma in Practical Finance & Accounts - Tally ERP 9
NICT
English and Kannada Typewriting - Higher Grade
Karnataka Secondary Education Examination Board
DCS computer course -
Aptech
Skills
- Good Knowledge of Computer Basics
- Attention to detail
- Basic Accounting Knowledge
- Good Typing Skills
Personal Information
- Father's Name: Raghuramaiah G
- Mother's Name: Seetha G.R
- Date of Birth: 10/16/77
- Gender: Male
- Nationality: Indian
- Marital Status: Married
- Religion: Hindu
Extracurricular Activities
Have been an active Cricket Player Interesting in Playing Chess & Carrom Listening to Music
Timeline
Sr. Executive - Medical Billing
Optimize RCM Pvt. Ltd
07.2024 - 05.2026
Sr. Executive - Medical Billing
Tharworx Pvt. Ltd
08.2020 - 06.2024
Senior Process Associate - Billing
Advantedge Health Solutions Pvt. Ltd.
02.2018 - 08.2019
Senior Quality Analyst – Billing
Logix Health Solutions Pvt. Ltd.
05.2014 - 07.2017
Process Associate
Cross domain Solutions Pvt. Ltd
08.2012 - 12.2013
Sr. Associate
EXL Pvt. Ltd
10.2009 - 05.2012
Process Associate
Omega Healthcare
10.2007 - 10.2009
04.2000 - 09.2007
Bachelor of Business Management -
Mangalore University
Diploma in Practical Finance & Accounts - Tally ERP 9
NICT
English and Kannada Typewriting - Higher Grade
Karnataka Secondary Education Examination Board
DCS computer course -
Aptech