Raj Kumar S.

Medical Billing & Credentialing Expert: HIPPA Certified Medical Biller

I am an enthusiastic and dedicated professional with extensive experience across all areas of Health Care / Medical Billing & Provider Credentialing – Revenue Cycle Management and collections management. An exceptional leader with potential management skills who is able to develop and motivate others to achieve targets and meeting the client’s requirements. I can demonstrate a strong ability to manage projects from conception through to successful completion. A proactive individual with a logical approach to challenges, I perform effectively even within a highly pressurized working environment. I am responsible for directing and coordinating the overall functions of the medical billing and coding office to ensure maximization of cash flow while improving patient, physician, and other customer relations. I have strong managerial, leadership, and business office skills, including critical thinking and the ability to produce and present detailed billing activity reports.  I have 16 Years of experience in Revenue Cycle Management in all parts of this domain.  Having experience of 6 years in Team handling, for Billing and Account Receivable and Patient Services.  Working as process leader to complete the transition of new clients and coordinating with onshore team to complete new clients Transition and Implementation. I also Participates in the development and implementation of operating policies and procedures.  Ensuring the Claims Relaying to payers from different Practice Management Tools smoothly and monitoring the rejection ratio from payer and clearing houses.  Having good exposure in understanding of EDI setups also worked on multiple software as Claims Remedy, Relay Health, Office Ally, Emdeon, Optum.  Analyzing billing and claims for accuracy and completeness; submit claims to proper insurance entities and follow up on any issues with the Billing and AR Team.  Ensuring the complete process followed by all teams as Payment Posting / Charges / Correspondence for different specialties and Account receivable.  Maintaining the SLAs for Team - Patient Services / Patient Statement client’s co-coordinating the collections to reduce the Patient AR.  Monitoring the Collections process to ensure the Collection of Patient AR in co-ordination with client for collections agencies.  Handling the client's with specialties as Radiology, lab Billing, Ophthalmology, Internal medicine, Ambulatory services, Gastroenterology, Physical Therapy, Surgery clients, Pediatric, Chiropractic.  Analyze trends impacting charges, coding, collection, and accounts receivable and take appropriate action to  Completing the Enrolment/Credentialing application on Paper, online for the Hospital providers and individual solo providers and sending to the payers via Fax, Email, Payer portal, by mail etc.  Verifying the applications, demographic update requests from the payer including Medicare/Medicaid direct and CMOs/Advantage Plans.  Creating & Managing the CAQH profile and doing the Re-attestation at every 90 days so provider profile is not expired.  Generating notification report to Providers/Account Managers (Administrators) about License, COI, Certification updates and expiration.  Working on Regular follow-up with Insurances about status of application in every 15 days to get the progress on the application.  Managing CMS revalidation/attestation for the providers.  Completing EDI Enrolment for the providers on the EDI platform.  Submitting Appeals for the Area/State where the panel is closed and provider is unable to get credentialed.  Creating credentials for the provider portal and submitting online application for faster processing.  Getting Approval letter, Effective date, provider id, plan types (credentialed with) and sharing with provider so they can start seeing patients and get reimbursed.