Summary
Overview
Work History
Education
Skills
Hobbies and Interests
Languages
Timeline
Generic
Lipson Thomas Mathew

Lipson Thomas Mathew

Hyderabad,India

Summary

SME-Operations with 9 years of work experience in US Healthcare, fully proficient with all aspects of training function and operation including: People management, maintaining SLA, audits and quality. A transformational leader with well-developed communication, interpersonal and problem solving skills. Adept in implementing procedures to facilitate a high-quality customer experience, while adhering to the project timelines. Understands how to motivate, plan, track, and monitor achievement of operational goals. Possesses seasoned abilities with identification of operational issues and the methods to address them.

Overview

9
9
years of professional experience

Work History

Subject Matter Expert

Cognizant Technology Solutions
10.2020 - Current
  • Maintain and manage process documents(SOP).
  • Prepare, manage and maintain the training materials.
  • Managing the operations of the team.
  • Driving SLA and KPI.
  • Root cause analysis (RCA).
  • Training of new hires.
  • Overlooking and ensuring a smooth workflow.
  • Motivating the team and solving problems.
  • Managing the schedule and delegating tasks to team members.
  • Strategizing plans to achieve team goals in a timely manner.
  • Creating and nurturing a positive work environment to boost productivity.
  • Coordinate between QA Team and operations team to ensure a feedback is provided to team and work on CAPA basis the audits.
  • Discussing and cascading important updates coming from client, QA team and management.
  • Preparing minutes of meeting (MOM) and sharing with the team.
  • Preparing daily production reports, attendance reports and ad hoc reports.

Senior Process Executive

Cognizant Technology Solutions
05.2018 - 09.2020
  • Insurance verification representative.
  • Medical billing - Durable Medical Equipment
  • Verify patient's eligibility and benefits through 270/271R, calling or from insurance website and calculate patient liability estimate.
  • Initiating prior/retro authorization with insurance through insurance portal/fax/call.
  • Based on each insurance policy/criteria review patient's clinical notes to determine if the DME product is medically necessary for the patient.
  • Communicating with client's onshore representatives/patient on the status on the claim/order.
  • Billing the claim to insurance after getting the auth approval.

Process Executive

Phycare Services(I) Pvt. Ltd.
08.2016 - 04.2018
  • Identify root causes of insurance denials, send appeals to payor and strive to minimize lost revenue.
  • Conduct account research and analysis.
  • Review provider claims that have not been paid by insurance companies.
  • Follow up with insurance companies to understand status of claims. Follow up is done through insurance portal or through outbound calls.
  • Based on information received from the insurance company make necessary corrections to the claim and re-file the corrected claim to the insurance company.
  • In case the claims has already been paid by the insurance company, request insurance company to send EOB(Explanation of benefits) through fax/mail.

Education

B.Tech - Electrical and Electronics Engineering

NRI Institute of Technology
04-2014

Skills

  • Efficient problem solving skills
  • Effective communication skills
  • Expert in delegating tasks
  • Mediator
  • Integrity
  • Positive attitude
  • Decisive
  • Time Management
  • Customer service
  • Employee Motivation
  • Employee training and development
  • Ability to Work under pressure
  • Fast Learner

Hobbies and Interests

  • Photography
  • Driving
  • Gardening
  • Listening to Music
  • Traveling

Languages

Malayalam
Native or Bilingual
English
Native or Bilingual
Hindi
Full Professional
Telugu
Full Professional
Tamil
Professional Working

Timeline

Subject Matter Expert

Cognizant Technology Solutions
10.2020 - Current

Senior Process Executive

Cognizant Technology Solutions
05.2018 - 09.2020

Process Executive

Phycare Services(I) Pvt. Ltd.
08.2016 - 04.2018

B.Tech - Electrical and Electronics Engineering

NRI Institute of Technology

Similar Profiles

CREATE PROFILE
Lipson Thomas Mathew