Summary
Overview
Work History
Education
Skills
Certification
Training
Timeline
Generic

Swetha Agnur

Phoenix,USA

Summary

Accomplished Senior Processor with a proven track record in managing high-volume processing tasks with strengths lie in problem-solving skills, keen attention to detail and efficiency in data management., ensuring compliance with industry regulations and company policies. Excelled in processing complex data files, mentoring employees, and leading projects to enhance operational efficiency. Skilled in multitasking and analytical thinking, significantly improved processing accuracy and team performance. Standout performer known for enhancing operational workflows that increase productivity. Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Results-oriented individual with a passion for continuous learning and innovation. Known for leveraging analytical thinking and creativity to solve problems and deliver high-impact solutions in fast-paced environments.

Overview

4
4
years of professional experience
1
1
Certification

Work History

Senior Processor

Infosys BPM
Phoenix, AZ
10.2022 - 05.2023
  • Processed exception files for multiple states, utilizing the iServe tool to handle customer requests and newborn enrollments through Call Tracking. Addressed issues and discrepancies across various projects in accordance with state portals and RDV.
  • Updated Coordination of Benefits (COB) as required to ensure accurate and timely processing. Verified the CVS application as per the customer's request for timely medication.
  • Entered data from applications into processing software, maintaining high data integrity. Identified areas where existing processes could be improved or where additional training was necessary. Offered administrative support to capture and transfer information.
  • Managed multiple applications simultaneously, prioritizing tasks to meet deadlines. Trained new resources on multiple exceptions.

Provider Data Specialist

Infosys BPM
Phoenix, AZ
09.2021 - 04.2022
  • Processed over 100 claims per day for multiple state programs that include Medicaid, Children's Health Insurance Program (CHIP), aged individuals, blind individuals, disabled individuals, and long-term services and supports. Adjusting claims with previous errors, denials, or claims that may have corrections upon the provider's request for reprocessing/reconsideration.
  • Verified the affiliations, added PAR and NON-PAR contracts, and processed claims accordingly. Processed PCRs (Provider Change Requests - loading new providers/groups, demographic updates, group/site affiliations, adding contracts) through the QuickBase tool and RBT PCR (adding/updating provider/group data in bulk) for multiple states through the ProData tool. Executed SQL queries through Drive and Drill tools for PCR, RBT processing, and validations.
  • Executed SQL queries through Drive and Drill tools for PCR, RBT bulk data processing, and validations.
  • Reviewed provider data submissions to ensure accuracy and completeness of information.
  • Updated and maintained databases with current information, as per the state portals.

Enrollment/Claims Processor for Horizon BCBS

Cognizant Technology Solutions, CTS
Phoenix, AZ
05.2021 - 09.2021
  • I handled data in Facets as per 834, EMEVS, and HIPAA Gateway Medicaid Enrollment applications. Processed hospital and medical claims after verification through HIPAA Gateway and Data Net to ensure proper billing practices from Par and non-Par providers.
  • Oversaw special project audits and reviews, as requested by other departments/regions. Reviews results timely, and come to independent conclusions that can be explained clearly and supported through data.
  • Used insurance rate standards to calculate premiums, refunds, commissions and adjustments.
  • Addressed customer inquiries to provide information and explanations on coverage and terms, expediting claims.

Senior Enrollment Specialist

Cognizant Technology Solutions, CTS
Phoenix, AZ
10.2019 - 09.2021
  • Handled new enrollments by entering customers' data and reviewing information. Worked on various queues in enrollment and various updates: Off-Exchange/On-Exchange programs, PCP updates, reinstatements, and updates through 834/DMR. Worked on the ticketing system for data processing through the OMNI tool.
  • Assisted in training new resources.
  • Prepared reports on enrollment statistics and discussed how to improve enrollment procedures during team meetings.
  • Granted, modified, denied, or terminated assistance based on key information and eligibility determination.
  • Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations.
  • Listened to and understood customers' needs, explained and discussed options and outlined best-fit services.
  • Answered questions and responded to inquiries to deliver high level of service to patients.
  • Maintained positive working relationship with fellow staff and management.

Education

Bachelors of Business Management -

SriKrishna Devaraya University
04.2013

Skills

  • Microsoft Excel
  • MS PowerPoint
  • Expert communication
  • Data file transferring
  • Data entry experience
  • Employee training and mentoring
  • Multitasking and prioritization
  • Analytical and critical thinking

Certification

Certified Scrum Master (CSM)

Training

  • Attended Scrum Master boot camp training.
  • Attended training for Facets Benefit and Technical foundation.
  • Attended QNXT and Softheon application training.

Timeline

Senior Processor

Infosys BPM
10.2022 - 05.2023

Provider Data Specialist

Infosys BPM
09.2021 - 04.2022

Enrollment/Claims Processor for Horizon BCBS

Cognizant Technology Solutions, CTS
05.2021 - 09.2021

Senior Enrollment Specialist

Cognizant Technology Solutions, CTS
10.2019 - 09.2021

Bachelors of Business Management -

SriKrishna Devaraya University

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Swetha Agnur