Analyzing an organization or business domain (real or hypothetical) and documents its business or processes or systems, assessing the business model or its integration with technology.Analyzing business domain known as CLAISMEASE LLC (Clearing house) working for 837P, 835 and 276 transactions and documenting its process as a business model.Responsible for integrating with payers directly wherever possible and create a list a list of payer with information of Direct Connection and front gateways.handling department of customer support for our product 5 offshores and 4 on shores, in order to make sure calls are answered with minimum Hold Time.Conducting training sessions for Cebu Philippines staff for customer support monthly in order to be more informative about the product.Regular assessment for Cebu Staff for improving on quality measures including regular feedbacks.Accountable for downloading the AR aging besides targeting the early resolution for accounts lying in 90+ categories for Claimease LLC serving Opthomological providers for state of New, New York and Michigan.Accountable for downloading the AR aging besides targeting the early resolution for accounts lying in 90+ categories for Claimease LLC serving Opthomological providers for state of New, New York and Michigan.

Handling different electronic standards 837, 835 270 for data mapping. Claims Submission, ERAs and Eligibility Inquiry/Response.Escalating issues to account managers and clients to get them resolved.Assignment of work to other team members in the absence of supervisor.Develop a strategy the team will use to reach its goalProvide any training that team members needCommunicate clear instructions to team members related to process.Listen to team members' feedback and providing solutions.Monitor team members' participation to ensure the training they providing is being put into use, and also to see if any additional training is neededManage the flow of day-to-day operations

Handling third party operations of Revenue Cycle Management (CHA) which includes ‘Eligibility & Benefits, Rejection handling, Claim Submission, Charge correction, Payment (EOB) posting, AR(Accounts Receivables), Denials & Appeals.

Handling new clients RCM Operations, Implementation, Training and Business Development. Areas to focus BD sales with the potentials leads with setting goal oriented.Assigning work to KPI measures and prevention guideline in order to reduce denials and working AR days.Publishing monthly and bi-weekly Reports for Clients and service providers Payment Shortfalls report, Insurance payments and productions reports.Maintaining Production, Quality and absenteeism Reports for Variable Pay month reports.Arranging resources of employee code of conduct to month performance. Contacting incoming potential leads to pitch about our billing and collection services. Coordination with Clients for new improvements and feedback's.Assisting Web and content team for improving our visibility in terms of growth and opportunities.

Working for Pediatricians under Anesthesia billing specially for new doctors inResponsible for Underpaid insurance claims and patient balancesMet or exceeded daily production and quality requirementsInteract with insurance carriers and third party administratorsReview and correct insurance denials for prompt payment to accounts as well as contact insurance carriers with issues pertaining to claims.Calling Insurance companies for unpaid, denied, underpaid claims for payment recovery.Arranging appeals/Medicare determinations for denied claims especially authorization.Majorly working for Cigna ,UHC ,Medicaid,BCBS & medicare etc Resolving status of claims & take necessary actions on besides meeting target up-to-date (Other Duties For development)Learned how to conduct mock sessions with new trainees whenever required.Call Employees for reminders regarding any updates for targets and contacting Doctors for adding more work.Work with management and groups to promote and facilitate process based knowledge.Maintain routine communication with employees to measures their goals leading healthy work atmosphere. Imparting training to new joinees. Conduct an orientation reminder of process responsibilities with executives in how to support the organization. Expertise in working on Underpaid claimsHandling client mails. Maintaining query log, Productivity log & Quality logEscalating queries to a next level.