MAATHESHWARAN T
Chennai,TN
Summary
Seeking a challenging position as a Prior Authorization Specialist within the US medical billing field, leveraging 4 plus years of experience to streamline authorization processes, optimize reimbursement rates, and ensure compliance with regulatory standards, ultimately contributing to the efficient operation and financial success of the organization.
Overview
5
5
years of professional experience
Work History
Senior Authorization specialist
Sage healthy private limited
04.2024 - 11.2024
- Review, prepare, and submit prior authorization requests in compliance with payer requirements.
- Monitor PA requests to ensure timely submission, tracking, and follow-up to avoid treatment delays. Address PA-related issues, including appeals for denied authorizations.
- Trained team members on best practices, insurance policies, and PA protocols to improve team efficiency and compliance.
- Conducted regular audits and reports on PA metrics, identifying areas for process improvement to maximize reimbursement and improve patient access
- Solving tickets and helping clients regarding the Authorization issues
- Splitting production hours to focus on several parts of PA and client tasks
- My areas of specialty include: PT, OT and Chiropractic services
Senior Authorization specialist
Business integrity services
08.2022 - 01.2024
- As a Prior Authorization Specialist, my responsibilities include contacting insurance companies to verify patients' benefits and eligibility prior to their treatment with the doctor.
- After completing the verification process, I determine whether authorization is required for the upcoming procedure.
- If authorization is necessary, I initiate the authorization process for the specific procedure the patient is scheduled to undergo.
- If authorization is not required for the procedure, I ensure that this information is documented in the medical billing software.
- Types of payers I work with include:
Health Insurance
Workers' Compensation
Motor Vehicle Accident (MVA)
- My areas of specialty include:
Pain Management
Home Health Care
Durable Medical Equipment (DME)
Prior Authorization specialist
AGS health
05.2022 - 08.2022
- As a Prior Authorization Specialist, I verify patients' insurance benefits and eligibility by contacting their insurance companies before treatment.
- After verification, I check if authorization is required for the procedure.
- If authorization is needed, I initiate the authorization process for that specific procedure.
- If authorization is not required, I document this in the medical billing software.
- Specialty: Multi Specialty.
Client success associate
Acidus Management solutions
01.2020 - 04.2022
- As a EV CALLER we make outbound calls to the insurance company to verify the patients benefits and eligibility before the patients gets treatment from the doctor.
- Verifications of Insurance Includes:
- Effective date and Termination dates
- Co-pay
- Co-insurance
- Individual & Family Deductible
- Frequency limitations
- Medical History
Education
BCA - Computer science and Applications
Kalasalingam University
01.2026
Data Analysis - undefined
Boston Institute of Analytics
01.2023
Skills
- RCM
- Prior Authorization
- Insurance verification
- Attention to detail
- Time management
- Communication
- Obtaining PA's from Attorney (MVA)
- Obtaining PA's from Adjuster (Workers compensation)
- Insurance calling
- Patient calling
- Prior authorization processing
- HIPAA compliance
- Documentation and paperwork
- Applicant support and service
- Eligibility procedures
Hobbies and Interests
- Learning New skills
- Stay Updated to the trend
- Actively educating myself from Linked in
Languages
Tamil
Native or Bilingual
English
Full Professional
Software
Athena, Epic, Kinnser, Chiro HD, Chiro Touch, Genesis, Proficient
Timeline
Senior Authorization specialist
Sage healthy private limited
04.2024 - 11.2024
Senior Authorization specialist
Business integrity services
08.2022 - 01.2024
Prior Authorization specialist
AGS health
05.2022 - 08.2022
Client success associate
Acidus Management solutions
01.2020 - 04.2022
Data Analysis - undefined
Boston Institute of Analytics
BCA - Computer science and Applications
Kalasalingam University
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