SUKEERTHI CHERUKURI
New Jersey,USA
Summary
Skilled & dynamic professional with more than 4.5 years of experience in US health care, Revenue Cycle Management. Experienced Credentialing Specialist adept at conducting application reviews and primary source verifications. Excellent relationship-building, problem-solving and communication skills. Reliable and competent Medical Billing professional with exceptional data entry and customer service skills. Detail-oriented professional with focus on deadlines and skilled in handling medical billing without errors. Confident Medical Biller knowledgeable in data confidentiality and privacy practices when reviewing patient information. Experience in handling wide variety of medical coding and billing tasks. Sophisticated and hardworking individual with excellent analytical and multitasking abilities. Coordinates with insurance companies and expedites claims processes. Expertise in accurately inputting procedure and diagnosis codes into billing software to generate invoices. Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. An established Insurance Verification Specialist known for handling various office tasks with undeniable ease.
Overview
5
5
years of professional experience
Work History
SENIOR QUALITY ANALYST/ AUDITOR/CREDENTIALING $ ENROLLMENT SPECIALIST
SUTHERLAND GLOBAL SOLUTIONS
05.2022 - 01.2023
- Having good knowledge in provider credentialing (Initial Credentialing and Re-Credentialing)
- Well versed in handing Provider Education, Board certificate, State License, State and Federal DEA, Hospital affiliations, Malpractice and action case history, CACTUS, SAM, OIG OPT OUT, providers licensure, NPI, insurance
- Works with staff to complete the CAQH re-attestation timely
- Responsible for the maintenance and continued monitoring of CAQH profiles and the credentialing system
- Auditing, & modifying the user worked accounts
- Maintenance of new updates, process knowledge and discussing the same in Team Huddles
- Executing the credentialing process for recording the qualifications of licensed medical professionals, along with authenticating their accuracy and correctness
- Devising development plans as well as incorporating effective methods for mitigating errors in the plans Offering mentoring & guidance to new joiners
- Works in collaboration with the manager to communicate any incomplete information impacting staff start date
- Works in collaboration with the billing department to ensure staff credentialing issues impacting billings are identified and resolved
- Organized daily audits for the Medical Billing Specialist claim work to determine its accuracy and quality along with administering the claim ratios for assigned clients
- Created & evaluated the reports of audit assessments & performance issues while engaged in recognizing trends, establishing constant quality enhancement initiatives, and catering to the ongoing training opportunities
- Received and evaluated applications to look for missing and inaccurate information.
- Enrolled providers and Medicaid, Medicare and private insurance plans.
- Collaborated with managers and client to identify and address users issues.
- Conducted performance reviews and provided feedback to user performance's an BQM session and weekly feedback session in Houston USA , Hyderabad, India
- Generated and analyzed reports to monitor employee engagement and attrition trends.
APPEALS SPECIALIST | APPEALS COORDINATOR
ASCENT BUSINESS SOLUTIONS
11.2020 - 05.2022
- Acted as a mentor for the team as well as performed similar responsibilities of a TL in their absence
- Coached & supported five junior associates in going live & also in possible deliverables completed by them
- Handled client DM reports & escalations while documenting the updates & trends related to global issues through the acquisition of weekly approvals
- Examining the outstanding monthly accounts receivable of each insurance, and process claims to achieve zero balances
- Handled the appeals as & when needed along with conveying various types of insurance Worked together with AR team to deliver response sessions for Reworks
- Created update trackers, PPTs, and Training manuals for mentoring new joiners
- Accountable for evaluating, auditing, and examining the client’s allocated Accounts Receivable for confirming desired quality, solving issues, & offering strategically beneficial resolutions
- Preparing appeals according to the appropriate federal, state, and requirements and regulations; and responding, by phone and email
- Enters denials and requests for appeal into the information system and prepares documentation for further review
- Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research
- Conduct outreach to members and providers for additional information required to resolve grievance and appeals cases
- This may involve placing outbound calls or sending faxes or e-mails
- Generating appeals or reconsiderations based on the dispute reason and contractual terms specific to the payer
- Identifying analysing, validating and research common root causes of denials, and create corrective action plans to resolve them.Conduct retrospective reviews of denials, submitting formal appeal letters, and persistently follow up with the payer to achieve optimal financial results
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Maintained confidentiality of patient finances, records, and health statuses.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
SPECIALIST| MEDICAL BILLING| CLAIMS SPECIALIST| DENAILS SPECIALIST
ELIBILITY, HINDUJA GLOBAL SOLUTIONS
05.2018 - 08.2020
- Understanding healthcare regulations such as HIPAA and Medicare guidelines is crucial to ensure compliance when handling patient information and processing claims
- Completes benefit plan builds for all HMO Managed Care plans by completing specification imports with all appropriate benefits
- Works eligibility work-queues for any eligibility and benefits issues
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Collected payments and applied to patient accounts.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Filed and updated patient information and medical records.
- Communicated effectively and extensively with other departments to resolve claims issues.
- Printed and reviewed monthly patient aging report and solicited overdue payments.
- Verified insurance of patients to determine eligibility.
- Reviewed patient diagnosis codes to verify accuracy and completeness.
- Delivered timely and accurate charge submissions.
- Audited and corrected billing and posting documents for accuracy.
- Utilized various software programs to process customer payments.
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
Education
MS Of Healthcare Managment - Healthcare Management
St. Francis College
Brooklyn, NY05.2024
MBA - Human Resources Management
St Joseph's Degree & PG College
Hyderabad, India05.2021
BBA - Commerce Accounts And Finance
St. Francis College For Women
Hyderabad, India05.2018
Skills
- Skills & Abilities
- Dashboard Preparation Performance Evaluation
- Credentialing Quality Assurance
- Plan Development Task Allocations
- Audit Processes
- Training Implementation
- Time Management
- Credentialing Requirements
- Provider Enrollment
- Claims Adjustments
- Customer Feedback
- Tracking Spreadsheets
- Past Due Balance Management
- Field Auditing
- Client Communication
- Diagnostic Codes
- Accounts Payable and Accounts Receivable
- Insurance Plan Verification
- Healthcare Terminology
- Outstanding Clerical Abilities
Accomplishments
Received an award in gratitude for outstanding individual contribution and seamless team support at Ascent Business Solutions Private Limited - Sept 2021
Obtained the honor for maintaining Quality and Quantity in productivity & taking up initiatives in all aspects and Best Team Player Award at Hinduja Global Solution- June 2019
Timeline
SENIOR QUALITY ANALYST/ AUDITOR/CREDENTIALING $ ENROLLMENT SPECIALIST
SUTHERLAND GLOBAL SOLUTIONS
05.2022 - 01.2023
APPEALS SPECIALIST | APPEALS COORDINATOR
ASCENT BUSINESS SOLUTIONS
11.2020 - 05.2022
SPECIALIST| MEDICAL BILLING| CLAIMS SPECIALIST| DENAILS SPECIALIST
ELIBILITY, HINDUJA GLOBAL SOLUTIONS
05.2018 - 08.2020
MS Of Healthcare Managment - Healthcare Management
St. Francis College
MBA - Human Resources Management
St Joseph's Degree & PG College
BBA - Commerce Accounts And Finance
St. Francis College For Women
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