Upendra Krishna Email & Phone Number

Dubai, United Arab Emirates

• Payer Empanelment.• Negotiate pricing, discounts and contract with payers taking into consideration efficient revenue generated network access.• Maintaining the confidentiality of payer proposals and final contracts.• Addition of new services with all payers.• Price list analysis & impact study by network. • Responsible for the self-pay pricing for all local and international patients/clients.• Ensures that agreed rates are uploaded into the HIS.• The service… Show more • Payer Empanelment.• Negotiate pricing, discounts and contract with payers taking into consideration efficient revenue generated network access.• Maintaining the confidentiality of payer proposals and final contracts.• Addition of new services with all payers.• Price list analysis & impact study by network. • Responsible for the self-pay pricing for all local and international patients/clients.• Ensures that agreed rates are uploaded into the HIS.• The service prices are fixed after analyzing and comparing with the competitor rates.• Verification of existing price list in HIS in order to nullify the price related rejections• Negotiation of volume rebate and fast track payments.• Registration of facility eclaimlink id and new / part-time doctors empanelment with payers.• Yearly monitoring of compliance with terms related to payer’s operational service and payments TAT whether to renew the contract or terminate. • Assisting collection team on payments & meeting the payers in case of delay in payment receipts.• Supporting in preparations of Volume Rebate and Fast Track Payments to payers.• Coordinating with payers in case of any unjustified rejections on the claims.• Initiate the sign off reconciliation (closing of books).• Coordinate insurance trainings with payers. Show less

Dubai, United Arab Emirates

• Managing all facilities RCM operations.• Insurance company empanelment for direct billing.• Creation of new services and mapping of the CPT code price list.• Responsible for tariff negotiations and discounts,• Monitoring claims submission and resubmission as per TAT.• Responsible for Payment collections, allocation, final reconciliation and closing of books.• Monitoring of ageing analysis to identify outstanding balances.• Training of all new staffs and doctors… Show more • Managing all facilities RCM operations.• Insurance company empanelment for direct billing.• Creation of new services and mapping of the CPT code price list.• Responsible for tariff negotiations and discounts,• Monitoring claims submission and resubmission as per TAT.• Responsible for Payment collections, allocation, final reconciliation and closing of books.• Monitoring of ageing analysis to identify outstanding balances.• Training of all new staffs and doctors with the protocols of the Insurance Companies• Preparations of Volume Rebate and Fast Track Payments as per agreed terms.• Evaluate the rejection reason on the monthly basis and formulate the corrective measures and coordinate with the concerned and reduce the percentage of rejections periodically.• Submission of Receivables Ageing to auditors for financial year closing.• Monitoring of insurance approvals. Show less

Majid Al Futtaim Healthcare

• Insurance company empanelment for direct billing, pricing, system updations.• Completely involved in RCM operations of 5 clinics and day to day insurance activities.• Contributed to process development in billing, insurance approvals and RCM.• Creation of new/additions to tariffs, with attention to cost + markup pricing of new procedures.• Systems Implementations & Readiness to (ICD10CM & CPT’s).• Monitoring claims submission and resubmission as per TAT.• Preparations… Show more • Insurance company empanelment for direct billing, pricing, system updations.• Completely involved in RCM operations of 5 clinics and day to day insurance activities.• Contributed to process development in billing, insurance approvals and RCM.• Creation of new/additions to tariffs, with attention to cost + markup pricing of new procedures.• Systems Implementations & Readiness to (ICD10CM & CPT’s).• Monitoring claims submission and resubmission as per TAT.• Preparations of Volume discount, Fast track payments.• Insurance Approvals are monitored. Show less

Dhcc, Dubai

• Associated with startup process of accounts receivables and insurance management.• Monitoring of TAT on monthly submission and re submission of claims.• Analyzing debtors ageing and monitoring of monthly collections.• Submission of outstanding statements to insurance co for overdue payments.• Prior zing the reconciliation statements for books closing.• External and internal auditor’s queries are responded promptly.

Chennai Area, India

• Handling day to day operations of the branch.• Coordinating with Insurance Company for Corporate and Individual Policies Float Fund.• Corporate Policy renewal meetings with the corporate relations team.• Collection of monthly TPA service Fee.• Managing the branch’s reimbursement and provider claims team, pre-auth team and call centre.• Monitoring of TAT on claims settlement.

Jeddah Governorate, Saudi Arabia

• Insurance accounts segregation to team members for claim submission & to monitor submission TAT.• Scrutinize the invoices and its documentation as per scope of its respective medical scheme.• Updating the new & renewal medical policies into the system profile as per scope of its respective medical scheme. (Approval limit, blocking the services for exclusions, R & B limit, Entitled networks, ded. / copays)• Submission of monthly reports to management on net billed, positive and… Show more • Insurance accounts segregation to team members for claim submission & to monitor submission TAT.• Scrutinize the invoices and its documentation as per scope of its respective medical scheme.• Updating the new & renewal medical policies into the system profile as per scope of its respective medical scheme. (Approval limit, blocking the services for exclusions, R & B limit, Entitled networks, ded. / copays)• Submission of monthly reports to management on net billed, positive and negative adjustment report. Show less

Chennai Area, India