Indira Priyadarsini Dandu
Dallas,TX
Summary
Experienced healthcare operations professional with over 8years in insurance claim processing, verification, billing across both public and private payer systems.TPA coordination, and ICD-10 coding. Proven track record in reducing claims cycle times, improving accuracy, and ensuring compliance with HIPAA and insurance guidelines. Strong background in patient communications, pre-authorizations, and root-cause analysis of denied claims. Excels in fast-paced, high-volume environments.insurance verification, billing optimization, and risk management. Proven track record in boosting gross margins, optimizing billing cycles, managing large teams,Adept at cross-functional collaboration with hospitals, TPAs, payers, and finance teams. Known for analytical thinking, operational excellence, and patient-first communication.
Overview
6
6
years of professional experience
Work History
Assistant Vice-President : Claim Investigation
HDFC ERGO General Insurance
Bengaluru, India
07.2023 - 01.2024
- 1. Leadership: Leading South Zone Risk and Loss Mitigation wing, have ample experience in effectively managing and motivating teams to achieve their best performance. Team management skills involve delegation, motivation, and performance evaluation, and driving the team to achieve highest results.
- 2. Claim Investigation: Excel in the thorough investigation of insurance claims, which includes evaluating evidence and ensuring compliance with established guidelines.
- 3. Vendor Management: Ability to manage external vendors for claim investigations and have good skills in negotiations , quality control, and efficient resource allocation.
- 4. Fraud Detection: Successful in identifying & dismantling fraud rings, showcasing expertise in fraud detection and had filed multiple FIR’s
- 5. Auditing: Experienced in conducting hospital and GMC audits, have a strong understanding on compliance and quality assurance procedures.
- 6. Evaluation of High-Value Claims: My expertise in assessing high-value personal accident and reimbursement claims unearthed many fraud nexus across industry.
- 7. Data Analysis: Efficient in evaluating team reports and make informed decisions, have strong data analysis skills, using relevant software and tools.
- 8. Legal Procedures: Coordinating with local police stations, filing FIRs, and attending ombudsman offices.
- 9. Training and Development: Training claim processors and transferring my knowledge and expertise to team members, contributing to their skill development.
- 10. Process Optimization: Monitoring end-to-end processes shows my continuous commitment to improving operational efficiency and streamlining workflows.
Deputy Zonal Manager -Claims & Insurance
Practo technologies Pvt Ltd
Bengaluru, India
12.2021 - 07.2023
- Worked to improve average order value, gross margin, and contribution margin by setting up billing & insurance function for Practo care Surgeries Business.
- Developed and implemented a hospital recommender to suggest the best hospital based on city, ailment, insurance, TPA, gross margin, average order value etc which helped increase GM by 4% and average order value by 12%
- Worked with supply team to renegotiate the hospital and doctor contracts which helped increase GM by 6%
- Conceptualized and executed various AOV improvement levers including right disease coding, ensuring accurate billing of consumables and equipment on the invoices, etc. which helped in increasing AOV by 7%
- Set up a 20+ members strong team and consistently achieved the targets on all strategic and operational metrics including AOV, gross margin, TAT adherence, insurance approvals, admission approvals, discharge approvals, etc.
- Reduced the hospital invoicing time by 50% which led to 15 days improvement in cash flow cycle for the business
- Collaborated with financing partners to offer interest free EMI / reimbursement options which help in improving the overall conversion by ~12%
- Verification and documentation of new patient insurance coverage and coordinating costs for supplies in order to communicate to the patient and billing the patient order cost
- Re-verification of existing patient insurance coverage to ensure that repeat surgery cost and eligibility is communicated to the patient and the hospital billing department.
- Contact insurance TPA’s to request any prior authorizations as needed for patients that must seek prior approval before obtaining medical supplies.
- Verification of insurance coverage of the patient through different insurance companies TPA’s via out bound phone calls
- Communication internally with Sales operations or Hospital Medical Billing operations of insurance eligibility for each new and existing patient in order to complete the sale or obtain further medical documentation.
- Communication externally with patients to explain information received relative to their insurance benefit and how it relates to their surgery
- Develops and maintains knowledge in medical terminology, billing and insurance guidelines
- Tracking daily team production and submit daily log to direct supervisor
Assistant Manager - Risk & Claims Audit (TPA)
Vidal Health care
Bangalore, India
08.2021 - 12.2021
- Assistant Manager Risk for Ayushman Bharat Scheme for the States which we are currently serving
- Representing the TPA in front of Insurance Company and State Health Authority and answering queries related to auditing and Processing of Claims
- Data analysis of claims and trigger-based audits of claims
- Prepare and Compilation of monthly Audit reports to be shared with States
- Training of Processors on Medical Aspects and new guidelines
- Provides administrative support to risk management team, handles claims and reviews data from insurers
- Reports monthly status of issues, action plans and key risk indicators to the Senior Leadership Team
- Assist management in monitoring compliance with corporate policies and practices and provide tracking and follow up for internal and external audit comments
- Provides incident management reporting to business identifying type of incident and root cause
Program Specialist -Patient Access & Reimbursement
Labcorp Testing laboratories company
Bangalore, India
03.2019 - 09.2021
- Processed patient assistance and drug reimbursement requests for high-cost medications.
- Reviewed medical necessity documents and insurance coverage policies.
- Handled escalations for eligibility verification and benefit authorization.
- Maintained documentation in compliance with U.S. HIPAA and internal QA standards.
- Used program knowledge and comprehensive analytical skills to review documents to process in a timely fashion
- Ensured compliance with Quality and control measures
- Maintained TAT specified for the task as per the quality for enhanced satisfaction level
- Used to Suggest the most viable solutions and generating ideas for the process improvement
Medical Officer - Claims Processing Support
Medi Assist Healthcare Services Ltd
Bangalore, India
11.2017 - 03.2019
- Processed and reviewed healthcare claims in compliance with insurance policies and regulatory guidelines.
- Verified patient information, policy coverage, and eligibility before claim adjudication.
- Ensured timely and accurate entry of claim details into claims management systems.
- Communicated with providers, policyholders, and internal departments to resolve claim discrepancies.
- Applied knowledge of CPT, ICD-10, and HCPCS codes to accurately interpret medical documentation.
- Investigated and resolved denied or pended claims by coordinating with billing and coding teams.
- Maintained confidentiality of patient data in accordance with HIPAA regulations.
- Achieved high claim accuracy and met daily productivity targets consistently.
Education
Graduation in Dental Surgery (BDS) - Bachelor of dental science
C.K.S Teja Institute of Dental Sciences & Research Centre
Tirupati, AP01.2016
Skills
- Understanding of commercial and medicare insurances
- Familiar with commercial and private insurance carriers
- Understands insurance benefits
- Close attention to detail
- Resourceful and reliable worker
- Excellent problem solver
- Adept multi-tasker
- ICD-10 (International Classification of Disease Systems)
- Maintains Strict Confidentiality
- Positive Attitude
- Insurance Companies
- Medical Terminology
- Private Insurance Carriers
- Patient Account Representative
- Patient Data
- HIPAA Compliance
- Medical Insurance Specialist
- Claim investigation
- Fraud detection
- Vendor management
- Process optimization
Disclaimer
I hereby declare that all the details given above are true to the best of my knowledge and I assure that I will work in the right earnest.
Accomplishments
ACE Award Recipient (5times) – Honored in 2019, 2020,2022, and 2023 for:
Consistently achieving highest productivity metrics
Driving highest revenue generation through operational excellence
Proactively completing tasks ahead of deadlines
Significantly reducing patient complaints related to billing through process improvements
Timeline
Assistant Vice-President : Claim Investigation
HDFC ERGO General Insurance
07.2023 - 01.2024
Deputy Zonal Manager -Claims & Insurance
Practo technologies Pvt Ltd
12.2021 - 07.2023
Assistant Manager - Risk & Claims Audit (TPA)
Vidal Health care
08.2021 - 12.2021
Program Specialist -Patient Access & Reimbursement
Labcorp Testing laboratories company
03.2019 - 09.2021
Medical Officer - Claims Processing Support
Medi Assist Healthcare Services Ltd
11.2017 - 03.2019
Graduation in Dental Surgery (BDS) - Bachelor of dental science
C.K.S Teja Institute of Dental Sciences & Research Centre
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