Suraj B.

Maintained correspondence records with insurance companies through emails and faxes, including important documents like corrected bills, medical records, remittance, repricing sheets, denial letters, and checks. Proactively identified and escalated issues, improving existing follow-up processes. Coordinated with client service teams and onsite representatives to address project-specific issues. Generated reports for tracking aging and high dollar claims, as well as forecasting cash collection and client reporting. Prepared and reviewed production and quality reports on a weekly and monthly basis. Regularly monitored process performance and implemented corrective actions as needed. Delivered refresher training to bridge knowledge gaps among team members and conducted monthly one-on-one reviews with team members. Analyzed technical process initiatives to provide opportunities for improvement and resolved inquiries from claim processors.

Identified and resolved issues related to provider and credentialing matters that affected claims processing. Conducted calls to payers for claim resolution on behalf of providers, including insurance follow-up on hospital claims. Managed denial resolution, recommending claims for reprocessing or review when necessary. Engaged with CA Medicaid, VI Medicaid, and MI Medicaid. Ensured individual productivity and accuracy targets were met, updating the team regularly and attending calls from medical insurance companies and patients. Maintained a record of correspondence with insurance companies through electronic communication regarding crucial documentation. Proactively improved existing follow-up processes and generated relevant reports for client communication.

Prioritized unpaid claims for calls based on their overdue duration, contacting insurance companies to advocate for outstanding claims payment. Evaluated and checked the status of unpaid insurance claims, transferring balances to patients when necessary. Allocated workloads on high-aged claims, consolidating team production while making necessary corrections based on insurer feedback. Gained experience with Professional Billing (CMS1500) claims forms.

Led a team of seven FTEs, managing daily operations including workload balancing and attendance to minimize customer impact. Reviewed production and quality reports shared on a weekly and monthly basis. Monitored process performance and executed corrective actions as necessary. Provided refresher training to address knowledge gaps within the team and conducted monthly one-on-one reviews for feedback. Coordinated with clients on process-related updates and was accountable for meeting production and quality targets. Responded to inquiries from claim processors and researched processing issues for resolution.

Conducted audits for duplicate and COB claims, using tools and resources to review and validate claim overpayments. Engaged in training for new algorithms while managing team metrics through daily reports, quality audits, and performance dashboards. Reviewed high dollar claims, supported the team in timely completion, and contributed to inventory management efforts. Addressed desk-level clarifications and conducted error review sessions to mitigate team errors.

Identified and addressed issues affecting provider payments, including credentialing and front-end rejections. Engaged with payers for claim resolution, conducting insurance follow-ups on hospital claims. Managed denial processes, ensuring claims were sent for reprocessing when denied incorrectly. Maintained correspondence records with insurance companies while collaborating with client service teams to resolve specific issues. Created reports to track high dollar claims and forecast cash collections, while also developing training documentation for new process associates.

Handled critical activities related to expediting, cost analysis, and supplier relations, following up with suppliers on purchase order confirmation. Managed requisition to purchase order conversion and adjusted POs according to demand forecasts. Synchronized with suppliers daily on open orders and ensured timely delivery of production parts while reporting status updates to management and requestors.