Parameswaran R

R. Parameswaran Contact: - Email:- Career Objective To learn and develop, myself and the organization with innovative ideas, by applying my thought, knowledge and various principles in my field, with the help of technology, friends and my colleagues. Work Experience Fort rich Healthcare Management Solution (March 2023 to Till Date) (SME, Team Lead) Clinic anywhere (USA), Work from Home, India (January 2019 to Feb 2023) (Account Receivable Specialist, QA) Access Health Care (May 2018 to January 2019) (Senior Client Partner) Medi-smart Solution (April 2015 to May 2018) (End to End process from Claims creation to Month end report creation PPT) Omega Health Care (Sep 2013 to March 2015) (Payment Poster) What I do Insurance Verification Process: • Check Eligibility • Verify coverage on all Primary and Secondary Insurance • Check Benefits for both in Network and Out of Network services • Obtain Authorization’s if needed • Contact patient if information such as Referrals or medical records needed Claims Creation: • Enter and check the billing details of the patient in the Billing software • Enter and check Referring/ Rendering provider’s information • Enter and check the primary payer & secondary payer’s information • Enter and check the valid Diagnosis codes & Procedure codes for the service date • Adding modifiers if required • Enter and check required billed amount for each procedures • Submitting the claims to payer in a timely manner Working on Rejection’s: Rejected claims will not be processed because they are not considered to have been “received” by the payer, thus do not make it into the adjudication system. • Correcting Errors and resubmitting on a daily basis • Print and mail claims if not set up for Electronic Data Interchange Accounts Receivables and Denial: Any claims which remain unpaid for various reasons. These claims are routinely followed up on a monthly basis. The reasons for rejections include • Authorization Issues • Referral Issues • Medical Necessity and Medical Records requests • Non- Participation with Insurance Network • Terminated Insurance • Timely Filing • Coordination of benefits • Wrong Diagnosis • Bundled Procedures • Partial Payments • Out of network claim status and deductibles • EDI Rejections • No status and Claim not on file • Maximum benefit reached • Need Primary Insurance EOB Maximum Reimbursement: Claims are followed up systemically and rapidly. Claim follow up is handled utilizing our electronic clearinghouse, insurance web portal and direct contact via telephone. I diligently pursue the claims for maximum reimbursement and appeal the denials. Claim Appeals: Denials and rejections are always handled by an appeal. Once the denial is evaluated, I utilize the appeal process to handle correct claims denials. Claims are never written off without being appealed first. Follow Up process: • Use various insurance company websites and internet payer portals check on the status of outstanding claims • Automated claims Follow Up (IVR) • Insurance Company Representative- If necessary calling a “Live” Insurance company representative will give us a more detailed reason for claim denials when such information is not available from either Portals or Automated phone systems • Claim correction and Resubmission done when required • Attached additional documentation if required • Appeal if needed with Medical records or proof of timely filing • Bill patients for Deductible, Coinsurance and Co-payment • Bill secondary with Primary payer’s payment information • In cases where partial payment are made, necessary steps and analysis initiated, after which corrective steps are taken Payment Posting: • Read EOBs/ ERAs accurately • Enter the payment details for each line item from EOBs accurately in the Billing Software • Transfer Patient balances • Create Deposit Batch on a daily basis • Review Auto posting • Upload EOBs after posting the payment in the Billing Software Medical Billing Reports: • The Billing service monthly end report • The Accounts Receivable Aging Report Key Skills • Ms Office • Following HIPAA Rules • Medical Billing • Medical Insurance • Online Claim Submission • Verify Benefits and Eligibility • Checked Insurance Web Portal, downloading the EOBs and also attached in billing software • Analyse the denials and took valid action • Submit the claims on time • Follow up the claims monthly wise Software’s used • Tebra • WRS Health • Athena • Nextgen Office Clearing House • Trizetto Solution (Gateway EDI) • Phi cure • Availity Academic Credentials Year Institution Board /University Qualification Percentage/CGPA 2013 C.A.R.E. School of Engineering, Trichy (T.N)  Anna University           B.E.(EEE) 6.34 2009 Vinmathee matriculation higher secondary school, Manapparai, Trichy (T.N)     State Board HSE 60% 2007 Vinmathee matriculation higher secondary school, Manapparai, Trichy (T.N)        Matriculation SSLC 53% Personal Details Name Father’s Name Date of Birth : : : R. Parameswaran N. Ramasamy- Languages known : Tamil (Read, Write, Speak) English (Read, Write, Speak) Gender : Male Marital Status : Single Nationality : Indian Experience : 12+ years in US Health care Medical Billing Declaration To offer services that would reimburse our Health Care providers 100%. To shoulder responsibilities for the benefits of the concern and will perform the duties assigned to me and the team to the entire satisfaction with passion. Place: Date: (R. Parameswaran)