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[QUOTE=Guest-IJT;125907]Durgesh Kumar 
 E-mail-durgesh12jul AT gmail.com 
PRESENT STATUS
Working with Inventurus Knowledge Solutions Private Ltd.
Inventurus is a leading global provider of Revenue Cycle Management  (RCM) services to the US healthcare provider market. Delivering value to  both inpatient and outpatient providers across a wide variety of  specialties; a partner in the success of our clients. 
Working as a Quality Analyst from Dec’ 2009 till date in Inventurus for  our client physiotherapy associates (PTA) our objective is to provide  defect free solutions to customer requirements.
 
Job Responsibilities 
- Audit of account receivables worked by an executive to ensure the accounts were addressed fully meeting the quality protocols.
- Provide feedbacks on the errors committed to the executives along with the team leads.
- Provide training to the executives in the areas, which they lack so that quality targets are met.
- Sending out daily quality scores and weekly quality reports to the operations team of an individual and teams performance.
- Weekly briefings with the assigned team for minimizing errors and to improve quality.
- Conducting meetings with the operations team to discuss process level  issues and concerns to sustain process growth adhering to client  requirements. 
- Attend client conference calls with the operations and quality team to  implement and/or update new strategies in the process flow for optimum  results. 
 
PRIOR WORK EXPERIENCE
(I) Accretive Health Services Pvt. Ltd.
Worked as an Analyst - Operation in patient financial services from June 09 to Dec 09. 
Job Responsibilities 
- Provide resolution on Medical, Medicaid, Auto Ins and Workers  Compensation claims by effectively communicating with insurance company.  
- Working on denials / issues related to solving of claims and benefits.
- Routine follow-ups on out-patient and in-patient claims which are  pending for information either from client’s end or patients to maintain  Productivity and Quality standards.
- Maintaining and Following Process Document Updates of clients for any change in resolving Accounts Receivable.
- Maintaining Database of accounts which require extensive follow-ups.
- Sending e-mails to client on specific accounts which require clarifications / approvals and working on feedbacks.
- Discuss queries in team briefing with team members and managers on resolving of accounts.
(II) UHG – United Health Group
Worked as a Claims Associate for One year from Feb 2008 to Jan 2009.
Job Responsibilities
- Adjudication of Hospital & Professional claim thru Facets.
- Verifying patient/insured benefits eligibility as well as providers credentialing and contract. 
- Working on provider network issues. 
- Specially involve in a process of Duplicate claims, Emergency and authorization issues and medical records received cases.
Achievements
- Employee of the Month Certificate from UHG.
- Quality Monarch Certificate from UHG.
- Quality Advisor Certificate from UHG. 
(III) ABN-AMRO Bank – Quality Cell
Worked with ABN as an Executive on behalf of Ismart Global BPO Pvt. Ltd. for 2 years from Feb 2006 to Jan 2008.
Job Responsibilities
- Quality check on information updated in the system with hardcopy of customer’s KYC updated by ACESS department.
- Providing feedback to the access associates and taking sign off. 
- QC includes for Loan and accounts info for individual, corporate, current account and insurance policies. 
- KYC maintenance report and document safely handover to the vendor RMC.
EDUCATIONAL QUALIFICATION
Month & Year Board Standard School/College Class
June 2005 Avadh University B. Com K. S. Saket PG College, Ayodhya, Faizabad II
June 2002 UP Board 12th MPLL Adarsh Inter College, Faizabad II
June 2000 UP Board 10th MPLL Adarsh Inter College, Faizabad II
ADDITIONAL QUALIFICATION
 “O” Level Computer Certificate from DOEACC Society (An autonomous body  of Department of information Technology, Ministry of Communication &  technology, Govt. of India for accreditation of Computer Courses under  the AICTE-DIT Scheme).[/QUOTE]

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