Vishnupriya Kamaraj
Chennai
Summary
Proactive Manager – Revenue Cycle Management & Coding with over 18 years' experience in Healthcare operations management. Possess demonstrated leadership abilities, strategic planning expertise and problem-solving acumen. Assist Senior Managers with accomplishing demanding targets by encouraging staff and coordinating resources. Resourceful Manager offering history of success coordinating and monitoring operations across various departments. Effective leader and problem-solver dedicated to streamlining operations to decrease costs and promote organizational efficiency. Highly committed with hardworking mentality to maintain quality of services and products.
Overview
18
18
years of professional experience
Work History
Senior Manager – Operations
10.2021 - Current
- Develop and execute strategic initiatives to optimize revenue cycle processes and improve financial performance
- Provide leadership and direction to teams involved in billing, coding, collections, and claims processing, ensuring alignment with organizational goals
- Monitor key performance indicators (KPIs) and metrics to assess revenue cycle performance and identify areas for enhancement
- Identify inefficiencies in revenue cycle workflows and implement solutions to streamline processes, reduce errors, and increase revenue capture
- Ensure adherence to regulatory requirements, coding standards, and billing guidelines to mitigate compliance risks and maintain ethical billing practices
- Oversee the implementation and optimization of revenue cycle management software and technology solutions to enhance automation and productivity
- Provide training and development opportunities for revenue cycle staff to enhance skills and knowledge in coding, billing, and other related areas
- Stay updated on industry trends, best practices, and regulatory changes to drive continuous improvement in revenue cycle operations and deliver exceptional results.
Manager- RCM & Coding
SCIO Management Solutions (P) Ltd
11.2019 - 10.2021
- Responsible for End to End transition Project Management, including scope, estimates, schedule and risks, till Closure Phase and Hand Over to delivery/run Operations
- Maximizing Customer Satisfaction level through Qualitative service delivery
- Monitoring the Progress of projects/programs, ensuring timely resolution of issues and implementation of corrective actions
- Producing detailed project plans to manage interdependencies and ensuring strict change control to manage deviations
- Supporting Service Excellence Reporting via the Service Excellence Dashboard
- Working on Client Requested Reports, Aging reports; correspondence; Clearinghouse and PM rejections
- Ability to work on Practice Management Reports, Provider Productivity Reports etc
- Evaluating Practice Performance Metrics
- Expert ability to add specific data such as modifiers, payer specific information, CPT and ICD-10 code
- Responsible for the processing and discrepancy reconciliation and closing of charge batches across all systems
- Work with clients and group to facilitate information and resolve charge questions
- Achieve goal of a 48-hour turnaround batch time
- Handling E&M audit process & working on Clinical Documentation Improvement
- Working on Clinical Research Billing co-ordinating with Research Sponsors for invoice.
Assistant Manager- Coding & Billing Specialist
SCIO Management Solutions (P) Ltd
07.2017 - 10.2019
- Interview & train employees on all areas of the coding and billing department
- Responsible for staff hiring, goal setting, coaching/training, performance evaluations and assistance in creation of employee development programs
- Responsible for receivables, cash collection, and revenue reporting
- Monitor staff performance, evaluating strengths and deficiencies, and provide necessary development
- Created and distributed operational, billing, accounts receivable, drugs profitability and trend reports
- Prepared and analyzed daily, monthly, year end and other reports as necessary
- Consistently met financial targets
- Monitored employee performance and developed improvement plans
- Provided current employees options for additional training opportunities
- Establish and monitor quality control benchmarks and report on same
- Responsible for managing and training a team of 50 Employees
- Conducted weekly meetings that consisted of addressing problematic accounts, resolving routine questions
- Credentialed physicians and other support staff with various payer sources.
Senior Account Manager
SCIO Management Solutions (P) Ltd
07.2013 - 06.2017
- Responded to staff and client inquiries regarding CPT and diagnosis codes
- Handle & resolve billing issues with patients & Insurance companies including refund
- Run monthly A/R reports & work in depth getting outstanding claims paid by resubmitting with corrected ICD-9/CPT Codes & submitting appeals with numerous Insurances
- Ability to read & properly evaluate Explanation of Benefits to ensure proper payment of claims
- Manages the reconciliation of accounts receivable on daily basis
- Processed billing for multi-practices involving ICD-9 /ICD-10 and CPT coding, initiating claims, and working with patients and carriers to guarantee payments
- Managed A/R activities for aged receivables
- Developed and implemented standard operating procedures to monitor work flow to ensure department ran at a maximum efficiency
- Reviewed, analyzed and monitored all statistical data related to accounts receivable
- Identified any negative trends that required resolutions and reported complex issues to higher levels of management.
Account Manager
SCIO Management Solutions (P) Ltd
07.2012 - 06.2013
- Reviewed and consulted monthly with providers to suggest improvements on A/R's
- Prepared monthly financial reports processed the aged accounts and made collection calls when appropriate
- Provided assistance to patients in understanding financial obligations as well as established payment arrangements for outstanding balances
- Maintain daily charge flow in Varian EHR to NextGen Practice Management System, oversight of daily charge submission utilizing Navicure Clearinghouse for electronic claim submission and claim editing
- Implemented policies and procedures manual to streamline billing processes
- Interactions with insurance companies, claims adjusters and patients
- Monthly and yearly spreadsheet reports.
Team Leader
SCIO Management Solutions (P) Ltd
07.2011 - 06.2012
- Responsible for maintaining the insurance coding and fee schedules along with the contracts in the electronic billing system and also prepared annual budget recommendations
- Dramatically improved billing procedures by introducing proactive management techniques and continuous process improvements
- Review and appeal unpaid and denied claims
- Monitor and update commercial fee schedules in comparison to Medicare reimbursement
- Ensure bills and related correspondences were mailed in a timely manner and kept track of physical copies and electronic files using legal software
- Filed appeals when necessary and kept abreast of current changes in billing requirements from government, managed care and other third party payers
- Effectively managed A/R's and claims appeals for any denials
- Coached, developed and motivated billing team.
Senior Group Coordinator
SCIO Management Solutions (P) Ltd
07.2010 - 06.2011
- Trained new and existing employees on Oncology billing guidelines
- Performed all appeal work after claim processing to maximize cash revenue
- Responsible for handling the Insurance billing claims and resolves the denied claims
- Provide financial report for daily, monthly and quarterly billing
- Minimized financial discrepancies by accurately analyzing report data and devising appropriate solutions
- Met all deadlines including those for month-end reporting.
Group Coordinator
SCIO Management Solutions (P) Ltd
06.2009 - 06.2010
- Oversee daily Billing team functions, including medical coding, charge entry, claims, payment posting, and reimbursement management
- Follow up on past due invoices and delinquent accounts to reduce number of unpaid and outstanding balances
- Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records
- Managed the reconciliation of accounts receivable and payable on a daily basis
- Received patient payments, recorded them in a database and provided receipts to patients
- Handled Provider and Client appeal/reconsideration request
- Reviewed claim denials and payer requirements for corrective action and prevention in the future
- Corrected and resubmitted claims denied by insurance company
- Provided Physicians with monthly reports of their receivable.
Senior Process Associate
A-One Biz Solutions P Ltd
07.2008 - 06.2009
- Download Electronic Remittances from clearinghouse for various insurance companies
- Post payments from both insurance companies and patients to proper accounts
- Review all payments to ensure correct reimbursement
- Run Patient Aging reports to send Patient statements
- Assisted in daily bank deposits including posting daily charges and payments
- Applied PPO contract according to client terms for low payment claims
- Researched and resolved denials and EOB rejections within standard billing cycle timeframe
- Quickly identified and resolved medical billing, coding and insurance discrepancies.
Process Associate
A-One Biz Solutions P Ltd
07.2007 - 06.2008
- Entered procedure and diagnosis codes into billing software to streamline account management; added modifiers, verified diagnosis, and coded narrative diagnosis
- Installed protocols to ensure all charges captures and billed appropriately
- Maintained accurate records and resolve billing issues
- Coding of inpatient and outpatient procedures from operative reports by using ICD 9 and CPT codes and applying modifiers when needed
- Submitted electronic/paper claims documentation for timely filing
- Maintained and updated all files including insurance companies, diagnosis, procedure, fees/profiles
- Performed Quality Assurance checks on Chemotherapy billing guidelines & charge entry transactions and account actions to assess compliance with state and federal regulations
- Worked on Level I Rejections after claims are transmitted to insurance
- Prepared Monthly Drug Audit report in order to find out the discrepancies in units billed with inventory system
- Shadowed senior team members to learn all related jobs.
Trainee-Process Associate
A-One Biz Solutions (P) Ltd
06.2006 - 06.2007
- Provided billing support to Physicians and data to assign ICD-9, CPT and HCPCS; enter diagnosis codes and patient information into billing software
- Received Physician's charges via a super bill and submitted electronically to insurance carriers
- Gained understanding of Chemotherapy –Infusion and Injection (I&I) billing guidelines
- Learned Radiology, Radiation and Hospital charges coding as well as billing guidelines
- Review and validate accuracy of charges, including dates of service, services provided, location, patient identification, and provider signature
- Entered billing data and submitted bills to insurance companies –private payers, Medicare and Medicaid
- Completed data entry and reviewed codes for accuracy prior to submission
- Learned new materials, processes quickly to maximize performance.
Trainee - Claims Processing Executive
Data Telesis Private Limited
01.2006 - 06.2006
- Attended training courses in to build understanding of industry
- Entered numerical data into database in a timely and accurate manner
- Processes claims, submitting accurate claims to insurance carriers
- Maintained high levels of efficiency during training by taking detailed notes and asking questions.
Education
Master in Business Administration (MBA)-Operations Management -
University of Madras
Post Graduate Diploma in Computer Science (PGDCS) - undefined
University of Madras
Bachelor of Commerce (B.Com) - undefined
Prince Shri Venkateshwara Arts And Science College
XII Standard - undefined
Shri Venkateshwara Higher Secondary School
X Standard - undefined
Prince Matriculation Higher Secondary School
Skills
Staff management
undefinedAapc Credentials
- Certified Professional Coder (CPC), 2012
- Certified Professional Biller (CPB), 2019
Practice Management Systems
- Centricity
- Medsym
- Intergy
- CureMD
- ECW
- Allscripts
- Lytec
- MicroMD
- Drchronos
- IMS
Electronic Health Records
- OncoEMR
- Genius Doc
- McKesson
- Sunrise
Clearinghouses
- Relay Health
- Trizetto
- Emdeon
- Navicure
- Payerpath
- Change Healthcare
Knowledge By Specialty
- Medical Oncology & Hematology
- Pulmonology
- Diagnostic Radiology
- Radiation Oncology
- Evaluation & Management
- Pathology and Laboratory
- Internal Medicine
Academic Professional Accomplishments
- Got First prize in English Essay Competition for the year 2000-2001.
- Got First prize in English Essay Competition for the year 2001-2002.
- Got Second prize in Tamil Essay Competition for the year 2001-2002.
- Secured Centum in Business Mathematics in the exam conducted during Apr'2003.
- Subject Topper in Business Management in the exam conducted during Apr'2004.
- Secured Centum in Cost Accounting in the exam conducted during Apr'2005.
- Received Merit Certificate of 100% Attendance in all three years of my Graduation between 2002-2005.
- Secured First Class with Distinction -95% in English Shorthand exam conducted during Oct'2005 in Stenographer's Guild, T.Nagar.
- Received certificate on completion of Self Development Programme during 2005 at Nibbana Growth Centre, Mylapore.
- Received the 'Best Performer of the Month' award after six months of employment in A-One Biz Solutions (P) Ltd.
Experience With Aapc
- Education Officer, 2020, 2022, AAPC Chennai India Local Chapter
- Proposed Fee schedule updates -2020, Nov'19, AAPC Chennai Local Chapter, 200+ members
- Injection & Infusion Coding Guidelines, Sept'23, AAPC Aurora Illinois Local Chapter, 100 members
- Employ 6 Metrics to Maximize Revenue, Healthcare Business Magazine, Apr'21
- I'm AAPC, Healthcare Business Magazine, May'22
- Lean Six Sigma Green Belt (LSSGB) - Benchmark Six Sigma
- Lean Six Sigma White Belt (LSSWB) - MF Treinamentos
- Lean Six Sigma Yellow Belt (LSSYB) - The Council for Six Sigma Certification (CSSC)
Areas Of Excellence
- ICD-10 Coding
- CPT coding
- HCPCS coding
- Anatomy & Physiology
- Medical Terminology
- HIPAA Compliance
- Managed Care (HMO,PPO,POS)
- Insurance Billing Procedures
- Insurance Claim Processing
- Government Payers
- Third-Party Payers
- Worker's Compensation
Timeline
Senior Manager – Operations
10.2021 - Current
Manager- RCM & Coding
SCIO Management Solutions (P) Ltd
11.2019 - 10.2021
Assistant Manager- Coding & Billing Specialist
SCIO Management Solutions (P) Ltd
07.2017 - 10.2019
Senior Account Manager
SCIO Management Solutions (P) Ltd
07.2013 - 06.2017
Account Manager
SCIO Management Solutions (P) Ltd
07.2012 - 06.2013
Team Leader
SCIO Management Solutions (P) Ltd
07.2011 - 06.2012
Senior Group Coordinator
SCIO Management Solutions (P) Ltd
07.2010 - 06.2011
Group Coordinator
SCIO Management Solutions (P) Ltd
06.2009 - 06.2010
Senior Process Associate
A-One Biz Solutions P Ltd
07.2008 - 06.2009
Process Associate
A-One Biz Solutions P Ltd
07.2007 - 06.2008
Trainee-Process Associate
A-One Biz Solutions (P) Ltd
06.2006 - 06.2007
Trainee - Claims Processing Executive
Data Telesis Private Limited
01.2006 - 06.2006
Master in Business Administration (MBA)-Operations Management -
University of Madras
Post Graduate Diploma in Computer Science (PGDCS) - undefined
University of Madras
Bachelor of Commerce (B.Com) - undefined
Prince Shri Venkateshwara Arts And Science College
XII Standard - undefined
Shri Venkateshwara Higher Secondary School
X Standard - undefined
Prince Matriculation Higher Secondary School
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