Somasundari Dilipkumar
Summary
An experienced professional in billing and coding with over 5+ years of experience having extensive knowledge with claims processes, collections techniques and customer crisis resolution. Experienced in ICD-10, CPT and HCPS coding. Exceptional in analyzing and validating patient information, diagnoses and billing data.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Account Representative
AUGMENT TECHNOLOGY SOLUTIONS
11.2022 - Current
- Virtual Conversing and Meeting Providers directly and understanding their requirements
- Convey the requirements to the account managers and team leaders and acquire the required datas
- Act like a mediator and acquiring the details from a provider's office, for creating a web portal, InstaMed, EFT/ERA Enrollment, EDI Enrollment with clearing house, credentialing of a provider and walk the providers/office assistants through the process, if needed
- Respond to all the emails for the practice, on behalf of the billing company
- Act like a mediator between the IPAs/IPA agents and the providers, on behalf of the billing company, to resolve bulk issues of the practice
- Managing 9 different practices involving around 40 providers of specialties like Palliative Care, Gastroenterology and Pulmonary Care, Behavioral, Internal Medicine, Family Medicine and Nephrology
- Identifying the problem on the bulk denials like NPI-Tax id issues, Provider Par-Non Par issues, Underpaid issues and call the insurance or speak to provider relations to resolve it
- Scheduling site visits with different Insurances or with Organizations like Advent Health etc with Doctors for any credentialing need
- Work on all queries of both the Provider and the billing office, working on the denials issuing refunds, payment EOB requirements, requests of Medical records from hospitals, working on subpoena, answering on all provider questions, conversion of paper checks to EFTs and vice versa, etc.
Medical Billing Specialist
ACE HEALTHCARE SOLUTIONS
04.2022 - 11.2022
- Work on denials by Various Insurances following FQHC (Federally Qualified Health Center) guidelines
- Working on rejections
- Attending patient calls and giving out information they need, strictly adhering to HIPAA guidelines
- Processing any payment from patient over phone
- Calling Insurance for claim status, eligibility, authorization and on any clarification
- Chatting with insurance agents in provider portals and working accordingly
- Appealing claims electronically and in paper with required documents.
Senior Executive Analyst
ACP SERVICES
04.2016 - 12.2016
- Work on all age days denial.
- Located errors and promptly refiled rejected claims.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Identified and resolved patient billing and payment issues.
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Communicated effectively and extensively with other departments to resolve claims issues.
- Liaised between patients, insurance companies, and billing office.
Senior Executive Analyst
AJUBA SOLUTIONS PVT LTD
06.2008 - 02.2012
- Work on priority mails and bulk issues whenever requested by client in order to make changes in the account as per latest billing market requirement
- Responsible for billing Insurance or patients for ER, Hospital, Lab and radiology services
- Handling Denial of claims, EOB's, Requests by Insurances, EOB printing, Rebilling and patient statements
- Train new comers on the software and various denials
- Providing quality reports for calling and payment denial agents on a regular basis for incentive purposes and to monitor efficiency
- Pulling 120+ age days accounts based on the insurance outstanding and taking action on it and creating reports on resolved accounts and pending accounts based on reason
- Verify patient's insurance coverage
- Maintain and analyze the patient's medical records and history
- Appeal claims whenever necessary
- Understand insurance rules and regulations.
Education
Bachelor of Science - Biochemistry
Valliammal College For Women
INDIA03.2008
Skills
- Profound knowledge on ICD 10, HCPCS and CPT codes
- Knowledge on various medical terminologies
- Knowledge of Claims, Provider Enrolments forms, W9 forms, Charity and Hardship letters, Patient statements etc
- Good in using different billing software (Meddata, NeuMD and RTI)
- Knowledge on the basics of Federal and Non- Federal insurances
- Able to spot medical billing errors
- Excellent Data Analysis
- Strong Leadership Qualities
- Strong Interpersonal skills
- Excellent typing speed
- Basics (MS-Word, MS-PowerPoint, MS-Excel) Internet Concepts, Ms-Access
Certification
- Certified Professional Coder, AAPC, 2022, 90%
- Certified Medical Reimbursement Specialist, AMBA-American Medical Billing Association, 2021, 86%
- Certified Clinic Account Technician, The American Association of Healthcare Administrative Management, 2011, Bronze Star
Accomplishments
- Have been an active head of Quality Controlling team of 7 members and have trained more than 70 members on medical billing process.
Timeline
Account Representative
AUGMENT TECHNOLOGY SOLUTIONS
11.2022 - Current
Medical Billing Specialist
ACE HEALTHCARE SOLUTIONS
04.2022 - 11.2022
Senior Executive Analyst
ACP SERVICES
04.2016 - 12.2016
Senior Executive Analyst
AJUBA SOLUTIONS PVT LTD
06.2008 - 02.2012
Bachelor of Science - Biochemistry
Valliammal College For Women
Similar Profiles
Lindsey WiseLindsey Wise
General Manager at Augment WellnessGeneral Manager at Augment Wellness
HARSHDEEP NARENDRA PATILHARSHDEEP NARENDRA PATIL
Intern at Augment Medical Simulation IndiaIntern at Augment Medical Simulation India
ANOOP V PANOOP V P
Sales Manager at Augment Renergytech Pvt LtdSales Manager at Augment Renergytech Pvt Ltd