Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Bhargava Jaswanth Y

Valparaiso,IN

Summary

Highly skilled professional with over 6 years of hands-on experience specializing in Healthcare Denial Management, backed by a Master's degree in Information Technology from Valparaiso University. Known for proficiently analyzing denial trends, overseeing the intricacies of Accounts Receivable (AR), and managing the complexities of insurance claims processes to ensure strict adherence to quality standards within the healthcare realm. Adept at resolving claim denials through strategic negotiation with insurance carriers and proficient in utilizing a range of programming languages, including Java, Python, JavaScript, SQL, R, and C#, for data analysis and software development initiatives. Recognized for a collaborative leadership style, exceptional communication prowess, and a demonstrated ability to excel in dynamic environments. Committed to driving continuous process improvements and delivering impactful solutions that optimize organizational performance at the dynamic intersection of healthcare and information technology.

Overview

7
7
years of professional experience
1
1
Certification

Work History

Subject Matter Expert

Primera Medical Technologies LLC
Hyderabad, Telangana
03.2021 - 07.2022
  • Proficiently managed and resolved customer escalations and client escalations as the focal point for the entire team. Demonstrated exceptional skill in addressing and mitigating concerns, ensuring client satisfaction and maintaining positive relationships. Implemented effective strategies to de-escalate situations and find mutually beneficial resolutions, showcasing leadership and problem-solving abilities in high-pressure environments.
  • Delivered comprehensive individual monthly reports to the Management Information Systems (MIS) team, facilitating informed decision-making and strategic planning. Orchestrated weekly meetings with clients to foster transparent communication, address concerns, and ensure alignment with project objectives. Acted as a liaison between internal stakeholders and external clients, promoting collaborative partnerships and enhancing overall project efficiency.
  • Assisted the team manager in compiling and analyzing reports on the team's monthly performance, providing valuable insights to drive strategic decision-making and improve operational efficiency. Collaborated closely with the management team to identify areas for improvement and implement targeted solutions, contributing to the overall success and productivity of the team. Demonstrated strong attention to detail and analytical skills in interpreting data and generating actionable recommendations to optimize team performance and achieve organizational goals.
  • Conducted regular team briefing sessions and quality meetings to ensure alignment with organizational goals and foster a culture of continuous improvement. Facilitated open discussions to address challenges, share best practices, and reinforce quality standards. Led interactive sessions to provide constructive feedback and promote professional development opportunities within the team. Through effective communication and collaboration, enhanced team cohesion and productivity while upholding high standards of excellence and accountability.
  • Dedicatedly supported employees by facilitating training and development activities aimed at enhancing their skills and capabilities. Collaborated with HR and departmental leaders to identify training needs and develop tailored programs to address them. Provided guidance and resources to help employees expand their knowledge base and advance their careers within the organization. Acted as a mentor and coach, offering personalized support and feedback to foster continuous learning and professional growth. By investing in employee development, contributed to a motivated and skilled workforce capable of meeting organizational objectives effectively.
  • Implemented proactive measures to monitor team performance and ensure the attainment of objectives. Utilized key performance indicators (KPIs) and metrics to track progress against targets and identify areas for improvement. Conducted regular performance evaluations and one-on-one meetings to provide feedback, address concerns, and offer support as needed. Collaborated with team members to establish clear goals and action plans, fostering accountability and driving results. Employed data-driven insights to make informed decisions and implement strategies to optimize team performance and maximize productivity. Through continuous monitoring and adjustment, ensured alignment with organizational goals and maintained a high level of performance excellence.
  • Regularly reported identified areas of improvement in the project to the project manager or supervisor, facilitating transparency and proactive problem-solving. Utilized data analysis and stakeholder feedback to pinpoint inefficiencies, bottlenecks, or areas lacking optimization. Presented actionable insights and recommendations for process enhancements, resource allocation adjustments, or strategic realignment to enhance project outcomes and efficiency. Collaborated closely with project stakeholders to prioritize improvement initiatives and implement effective solutions, fostering a culture of continuous improvement and innovation within the project team. By proactively addressing areas of improvement, contributed to the project's overall success and sustainability. Researching on difficult tasks and finding route cause analysis to resolve the tasks in time
  • Conducted regular refresher sessions for employees aimed at enhancing performance and reducing defects. Developed engaging and informative training materials tailored to address specific skill gaps and areas for improvement. Utilized real-world examples and interactive exercises to reinforce best practices and promote a deeper understanding of quality standards. Collaborated with subject matter experts to incorporate the latest industry trends and techniques into training sessions. Encouraged active participation and feedback from employees to foster a culture of continuous learning and improvement. Monitored performance metrics and defect rates to assess the effectiveness of training initiatives and make adjustments as needed. By investing in employee development, contributed to higher levels of productivity, efficiency, and quality within the organization.
  • Regularly engaged in day-to-day interactions with top management and the IT team to identify opportunities for automation, streamlining processes where human intervention is unnecessary, and providing essential information and data. Collaborated closely with key stakeholders to assess workflow inefficiencies and determine suitable automation solutions. Facilitated communication between departments to ensure alignment with organizational objectives and technical capabilities. Demonstrated effective project management skills in coordinating automation efforts, from initial assessment to implementation and ongoing monitoring. By leveraging technology and fostering cross-functional collaboration, contributed to increased efficiency, reduced operational costs, and improved data accuracy across the organization.

Revenue Cycle Officer (SME)

IKS Health Services
Hyderabad, Telangana
08.2019 - 03.2021
  • Identified and promptly escalated global issues within the assigned payers to the supervisor, demonstrating keen attention to detail and proactive problem-solving skills. Utilized comprehensive understanding of payer policies and procedures to recognize systemic issues impacting operations or customer experience. Collaborated with cross-functional teams to gather relevant data and insights, ensuring accurate assessment and effective resolution of issues. Communicated findings and recommendations clearly and concisely to the supervisor, enabling informed decision-making and timely action. By highlighting and addressing global issues, contributed to enhanced efficiency, compliance, and customer satisfaction within the organization.
  • Meticulously researched and meticulously reviewed individual and group claims, applying a robust understanding of major medical plans and prominent healthcare networks. Leveraged comprehensive knowledge of plan intricacies and network protocols to assess claim accuracy and validity. Employed critical thinking and analytical skills to identify discrepancies, inconsistencies, and potential areas of improvement. Collaborated with internal teams and external stakeholders to resolve complex claims issues efficiently and effectively. By demonstrating expertise in claim processing and plan management, contributed to maintaining high standards of accuracy, compliance, and customer satisfaction within the organization.
  • Managed the real-time identification and resolution of website issues while concurrently overseeing healthcare denial management processes, utilizing advanced tools and cross-functional collaboration to ensure seamless operations and optimal revenue cycle performance.
  • Motivated and empowered every team member to strive for excellence and deliver their utmost performance, fostering a culture of dedication and achievement throughout the team.
  • Defined and allocated specific duties and responsibilities to individuals within the team, ensuring clarity of roles and fostering accountability for effective collaboration and task execution.
  • Conducted thorough analysis of assigned projects and strategically distributed tasks among team members based on their areas of expertise and skill sets, optimizing project execution and fostering efficient utilization of resources.
  • Administered monthly Process Knowledge Tests to evaluate team members' comprehension of key processes, protocols, and procedures. Delivered constructive feedback based on test results to guide individuals in areas requiring improvement, fostering continuous learning and professional development within the team.

Senior Associate

Tata Consultancy Services
Hyderabad, Telangana
05.2018 - 08.2019
  • Led the development and implementation of a comprehensive Business Continuity Plan (BCP), ensuring readiness for potential disruptions and minimizing operational downtime. Established and operationalized a 30-member team in Hyderabad, overseeing recruitment, training, and onboarding processes to build a capable workforce aligned with organizational objectives.
  • Managed client calls with a focus on maintaining high service standards and adherence to Standard Operating Procedures (SOPs). Ensured clear communication and resolution of client inquiries while consistently following established protocols to guarantee service consistency and quality.
  • Conducted quality audits in the event of a Quality Auditor's absence, ensuring continuity of quality assurance processes. Reviewed procedures, documentation, and performance metrics to uphold standards and identify areas for improvement, maintaining consistency and integrity within the quality management system.
  • Possess extensive experience across various healthcare processes including Emergency Services, General Surgery, and Physiotherapy. Proficient in managing Scrubber rejections, clearing house rejections, Accounts Receivable (AR), Denials, Appeals, and effectively handling voicemails within healthcare settings.
  • Assisted new joiners by providing comprehensive training on HIPAA modules and various internal procedures. Ensured thorough understanding and compliance with HIPAA regulations and internal protocols to maintain confidentiality and security of patient information. Facilitated smooth integration of new employees into the organization's workflow through tailored training sessions and ongoing support.
  • Regularly prepared and disseminated production reports and end-of-day summaries to supervisors, providing detailed insights into daily operations and performance metrics. Ensured timely and accurate communication of key data points, allowing supervisors to make informed decisions and take necessary actions to optimize productivity and workflow efficiency.

Associate

Tata Consultancy Services
Hyderabad, Telangana
09.2015 - 05.2018
  • Served as a critical resource for a pilot batch consisting of 40 associates, providing essential guidance, support, and mentorship throughout their training and onboarding process. Offered expertise, answered queries, and facilitated smooth integration into the organization, ensuring a positive learning experience and successful transition for all associates involved.
  • Performed Accounts Receivable (AR) follow-up with insurance providers, systematically checking eligibility and benefits for claim coverage. Analyzed Explanation of Benefits (EOB) statements meticulously to identify discrepancies or denials, initiating timely correspondence and engaging in proactive communication with insurance representatives to resolve issues and appeal denied claims efficiently.
  • Regularly checked the status of filed claims to ensure timely processing and reimbursement. Monitored claims through various stages of the adjudication process, including submission, review, and payment. Proactively followed up on outstanding claims, liaising with insurance carriers and other relevant parties to resolve any delays or issues promptly. Maintained accurate records and documentation to track claim status and facilitate efficient revenue cycle management.
  • Conducted thorough review of denial reasons for outstanding claims to identify root causes and address underlying issues. Analyzed denial codes and explanations provided by insurance carriers to understand the reasons for claim rejection or non-payment. Collaborated with internal teams and insurance representatives to resolve discrepancies, appeal denials, and take necessary corrective actions to resubmit claims for reimbursement. Implemented strategies to minimize future claim denials and optimize revenue cycle performance.
  • Performed diligent follow-up on claims that received no response from insurance carriers within the expected timeframe. Implemented systematic procedures to track and prioritize outstanding claims, ensuring timely resolution and maximum reimbursement. Engaged in proactive communication with insurance representatives to inquire about the status of pending claims, identify any potential issues causing delays, and expedite the adjudication process. Utilized effective follow-up strategies to minimize claim processing time and optimize revenue cycle efficiency.
  • Reviewed insurance information provided by patients to assess its adequacy and clarity for claims processing. Identified any discrepancies, inaccuracies, or missing details that could hinder claim submission or reimbursement. Proactively communicated with patients to clarify and obtain accurate insurance information as needed, ensuring smooth and timely processing of claims. Collaborated with patient registration and billing teams to address any issues or discrepancies, ultimately optimizing the revenue cycle and enhancing patient satisfaction.
  • Verified and reviewed insurance information for self-pay patients to ensure accuracy and completeness. Assessed the eligibility of self-pay patients for insurance coverage or assistance programs. Provided guidance and assistance to patients in navigating insurance options, understanding coverage benefits, and exploring alternative payment arrangements. Collaborated with financial counselors and patient advocates to facilitate appropriate billing and payment processes for self-pay patients, aiming to minimize financial burdens and ensure equitable access to healthcare services.
  • Gathered information on claims pended by insurance companies, which involves identifying the reasons for the delay in processing. Engaged with insurance representatives to obtain detailed explanations for claim pendency, including missing information, coding errors, or eligibility issues. Implemented systematic procedures to track and prioritize pended claims, facilitating timely resolution and resubmission as necessary. Collaborated with internal teams to address underlying issues and prevent future claim pendency, optimizing revenue cycle efficiency and ensuring timely reimbursement.
  • Developed and curated comprehensive information on insurance denial strategies to support training initiatives. Compiled data on common denial reasons, appeal procedures, and effective resolution tactics. Maintained up-to-date resources and documentation to facilitate ongoing training sessions for staff members involved in denial management. Continuously reviewed and updated materials to reflect changes in insurance policies and industry best practices. By providing valuable insights and resources, contributed to the professional development and proficiency of team members in effectively addressing insurance denials.
  • Consistently met productivity targets within designated timelines while ensuring that client deliverables adhered to rigorous quality standards. Implemented efficient workflows and processes to optimize productivity without compromising on quality. Regularly monitored progress and performance metrics to identify areas for improvement and proactively address any deviations from targets. Maintained a strong focus on quality assurance protocols, conducting regular reviews and audits to uphold high standards of excellence in all client deliverables. By prioritizing both productivity and quality, contributed to the overall success and satisfaction of clients and stakeholders.

Education

Master of Science - Information Technology

Valparaiso University
Valparaiso, IN
12-2023

BBA - Finance

Dharwad College of Management
Dharwad, Karnataka
07-2015

Skills

  • Strong Analytical Skills
  • Training and Mentoring
  • Strategic Thinking
  • Research Capabilities
  • Project Planning
  • Excellent Communication
  • Continuous Improvement
  • Attention to Detail
  • Quantitative Skills
  • Interpersonal Communication
  • Content Management Expertise
  • Trend Tracking
  • HIPAA Regulations

Certification

  • Java
  • Python
  • Javascript
  • SQL

Timeline

Subject Matter Expert

Primera Medical Technologies LLC
03.2021 - 07.2022

Revenue Cycle Officer (SME)

IKS Health Services
08.2019 - 03.2021

Senior Associate

Tata Consultancy Services
05.2018 - 08.2019

Associate

Tata Consultancy Services
09.2015 - 05.2018

Master of Science - Information Technology

Valparaiso University

BBA - Finance

Dharwad College of Management

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Bhargava Jaswanth Y