Shivashankar R

CURRICULUM VITAE Shivashankar R Mobile: - EMail- Summary: US Healthcare professional with 9 Years of experience Claims (Payer) and Provider Operations Well acquainted with New Business Strategies, terminologies of US Health Care, Claims Processing, Good knowledge of HIPAA Expertise in Claims Adjudication, Provider Loading, Provider contract setups Academic Qualification:     DEGREE INSTITUTION UNIVERSITY /BOARD YEAR OF PASSING CLASS SECURED Graduation B.com Vivekananda Degree College. Bangalore  University 2007 59% STANDARD 12 Govt PU College Peenya Karnataka PU Board 2004 63% STANDARD 10 Vinodh English High School Karnataka Board of Secondary Education 2001 67%   Work Experience Organization-1: Hinduja Global Solutions Designation:Claims Processing Executive Period:Feb-2010 to Feb-2012. Organization-2: United Health Care (XLHealth Corporation India Pvt Ltd) Designation:Sr. PDAR Analyst (SME) Period: 10th Dec 2012 to till date. ACHIEVEMENTS: Represented Bangalore University Cricket team for South Zone InterUniversity Tournament in the year 2005-06. Represented Karnataka Indoor Cricket Team for 7th National Championship in the year 2007-08. Primary Roles & Responsibilities: Verifying and Validating Provider records in Facets and maintaining provider network database Analyze and investigate the issue received from various escalations points internally and address them exclusively within specific knowledge area Work closely with team members to meet production and quality standards using established guidelines, procedure and policies Identifying, escalating priority issues and reporting to the immediate reporting staff Clearing ageing claims on all different workflows on top priority basis and keep ageing in control Obtaining regular feedback on performance / pertinent data and facts to identify and solve range of problems within area of expertise Compile and report daily team reports and frequent management reports Regular follow-ups on audits and provide feedbacks to team members to reduce errors and improve process performance Lead and participate in all initiatives related to management / support and improvements Ensure compliance with business requirements Adopt and promote company’s values in the daily functions Maintain current knowledge of business / functional strategies , rules and procedures Application Expertise: NDM NDB NPPES Facets MTV STRENTHTS: Responsible Time Management Strong communication, interpersonal and negotiation skills Quick learner and Adaptable Motivated and dedicated to getting the job done right. Courteous and professional Flexible to work in any shift Personal details:  Date of Birth 05th May 1983 Sex Male Nationality Indian Marital Status Married Languages Known English, Hindi, Kannada,Telugu,Marathi PAN ADDRESS CEBPS7366Q #320,2nd main,6th cross Lakshmidevinagar,Nandinilayout (post) Bangalore-560096.   Declaration: I testify that the above details are authentic, and I alone shall be responsible for any erroneous information provided.  Bangalore Shivashankar R