Medplexus India Pvt Ltd Hyderabad : AR Calling , US healthcare Insurance System

[mskavi]

Company Name: Medplexus India Private Limited
Website: http://www.medplexus.com

Company Profile
Medplexus provides integrated scheduling, billing
and EMR/EHR software applications specifically designed for physician offices. Medplexus provides billing services and management of the entire revenue cycle.

AR CALLER - US healthcare - Medical Billing Process
Medplexus India Private Limited

Experience: 1 - 3 Years
Location: Hyderabad / Secunderabad

Job Description
AR Follow up with Insurance and Patient.
Checking Eligibility and Benefits
Analyze EOB, correspondence and call insurance for denied claims
Develop and maintain information about insurance denial strategies for training purposes

Desired Candidate Profile
Min 6 months experience in AR Calling
Good Knowledge in US healthcare Insurance Systems
Should have handled Insurance Denials
Ability to perform Pre-call analysis for prospective calling
Focused on result oriented activities

Email Address: phani.medplexus@gmail.com

Keywords: AR Calling, Medical Billing, US healthcare, Accounts Receivables, Process Executives, Sr Process Executives

[Syed Ashhar]

SYED ASHHAR UDDIN
Mobile: 09393334612
09399994612
E-mail: asyed AT westlinemed.com
syedashhar AT gmail.com

Career Objective:
Quest to work in professional atmosphere that well help me to expand knowledge regarding the new technologies and as well provides me the scope for widening the continuum of my knowledge & experience.

Educational Qualification:
- M.com (first year) from PGRR Distance Education, Osmania University.
- B.com (Taxation) from Pragathi mahavidyalaya Degree and P.G. College, Hanuman Tekdi with 60% aggregate.
- Intermediate from Govt Jr. College, Chanchalguda with 74% aggregate.
- SSC from Adams High School, New Malakpet with 69% aggregate.

Experience Summary :
Over Two Years of Experience as an Assistant Accountant:-
C. Ramchandram & Co., Chartered Accountants.
3-6-237, unit # 606,
Lingapur La Building Complex,
Himayathnagar,
Hyderabad – 500029.

Job Responsibilities:-
- Developed several Excel spreadsheet macros currently in use for reducing entry time and automatically cross-referencing for errors.
- Prepare checks based on the Invoice as summarized on the journal vouchers from accountants department.
- Excellent ability to use word processing equipment and/or software applications on personal computer.
- Reviewing of various Invoices and Vouchers.
- Auditing of various Journal vouchers, Invoices, Cash receipts & books of accountants.

Presently Working:-
Working for M/S Accurate Billing & Consulting Services, a US Health Care BPO as a Team Leader.
Clients: Client facilities located at USA California region.
Description: Working on payer source billing like Medicare, Medi-Cal, HMO, and Hospice & Private. Auditing on claims outstanding for more than 60 days & processing the claims.
Over 2 yrs of experience in US healthcare BPO with covering aspects of AR process. Through experience in cash postings, pay source billing, claims processing, denials working and Auditing as an associate.

Key Responsibilities:-
- Billing the patient UB04’S.
- Claim processing and checking the claims for pay status on daily basis, next day from the date of submission and keep following up until the claim gets paid.
- Immediate follow up on the denied claims.
- Calling on the entire high dollar claims for status and working in co-ordination with Insurance representatives and staff at client office.
- Looking into cash collections files and follow up for unrealized collections.
- Exertion on high dollar accountants.

Accountability:-
- Assigning accounts to associates, when we get e-fax.
- Looking into quality related Issues and come up with better ways to achieve 100% quality.
- Hold team meetings to discuss about new scenarios and day to day Issues.
- Co-ordinate with the Quality Audit team to monitor the compliance audits and ensures adherence to the compliance policies and procedures.
- Set and assess associates performance expectations and create individual action plan.
- Sending weekly productivity reports.
- Mentoring and monitoring new associates on the project to get them on par with projects standards of quality and productivity.
- Documenting the process and adopting the best practice to create synergy and Improve work performance.
- Looking into any training related Issues for the team members.
- Generating of various analysis reports, tracking aging and high dollar claims, Monitor quality/productivity, forecasting cash collection reports, project management requirements and client reporting.

Achievements, Accomplishments :
- Received an Appreciation from the client (PRESIDENT) for providing the best Information on claims (In short period of four months from the date of joining).
- Received the title of Team Leader with my phenomenal success and hard work that I have been committed towards my process (In short period of 1 yr from the date of joining).
- Appreciation from the client management team for Good collections in a month.
- Appreciation from the Staff Accountant (USA) for clearing the old denied claims for the payment.
- College topper in Intermediate.

Summary of skills:
- Excellent human relation skills and rapport with client.
- Superior ability to achieve immediate and long-term goals.
- Ability to execute multiple projects simultaneously.
- Proven ability to analyze, plan, manages and motivate.
- Effective written and oral communication skills.

Software Exposure:
- Packages : Tally 7.2 (with VAT & service tax)
- Web Technologies : HTML
- Applications : MS Office, MS DOS, Windows NT.
- Through experience in handling multiple software’s also Medicare program and Medi-cal websites.

Strengths:
- Hardworking with positive attitude.
- Quick learner.
- Good in grasping knowledge quickly.

Hobbies:
- Reading Newspaper.
- Surfing Net.
- Watching Wrestling.

Personal Details:
Father Name : Syed Atharuddin.
Date of Birth : 06-01-1985
Marital Status : Single
Languages Known : English, Hindi, and Urdu.
Gender : Male
Nationality : Indian
Religion : Muslim
Passport # : F6766614
Contact No : 09393334612
09399994612

Address for Communication : Syed Ashhar Uddin
H.No: 17-9-566, Chanchalguda,
Malakpet.
Hyderabad - 500 023.

Place:-

[Hyderabad] [Syed Ashhar Uddin]

[Guest]

CURRICULUM VITAE
B.ARUNKUMAR
E-mail Id : arun.dj66 AT yahoo.com
Objective :
To make optimum use of my talents in a growth – oriented organization and to contribute effectively towards achieving organizational goals for a reputed organization.
Work Experience :.
> Worked for Vodafone in Backend Process in Activations (Audits) for 2.yrs.
> Working in Domain Networking Zone from the period of 1 yr.
Educational Qualifications :
Graduation (B.com)from Little Flower Degree College
Intermediate from ken Junior College Lalbazar
Schooling from St Mary’s High School Hasmatpet
Additional Qualification :
MS-Office Suite
Windows system administration on 2003
Typing Speed AT 38-40 wpm
Strengths
1 Hard Working
2. Dedicated towards work
3. Good Representation Skills
RESPONSIBILITIES :
Worked as a team coordinator,
Responsible for service activation & quality in applications for new connections.
Authentication of documents submitted by companies for group connections and corporate connections.
Responsible for quality audits activated post paid CAF’s entire A.P.
Verification of accuracy in service activations.
Rectifying errors done at the time of activation and report the same to the manager.
Responsible for Fraud control & service activation, quality in applications for new connections.

[snehal@1]

CURRICULAM VITAE
Snehal khobragade
Email : jiyapiyatiya AT yahoo.co.in
Educational Qualification :
Board School or College Passed year Percentage
SSC Shivram Vidayalaya 2004-05 58%
HSSC Matoshri Kashidevi Junior Collage 2010-11 41%
Diploma in information Technology & Electronic System Maintenance Industrial Training Institute , Nagpur 2005-07 71%
Bachelor of Business Administration M.J. College , Nagpur 2011-00 Pursuing
Work Experience :
- Worked in Vcustomer Pune for 8 months as a CCE in an Inbound Call Centre for US online shoping from September 2008 to Apirl 2009.
- Worked in Ascent Business Solutions Ltd, Nagpur for 26months as an Billing Executive(US-Healthcare) , Software’s like AdvancedMD, Centricity EMed’s & Practice specialties like Internal Medicines, Pediatric & Cardiologist . If selected I assure you to discharge appreciative work, Worked from June 2009 to August 2011.

[Guest]

CURRICULUM VITAE
C.PAVAN KUMAR
Email : pavankumar_leo2004 AT yahoo.com
OBJECTIVE :
To work in a dynamic and technology driven environment where I can enhance my skills and achieve personal growth as well as that of the organization.
ACADEMICS CREDENTIALS :
- Bachelor of Commerce from St.Patricks Degree College.
- Intermediate from Vagdevi Junior College.
- S.S.C from Nalanda High School.
TECHNICAL CREDENTIALS :
Advanced Diploma in Software Technology (ECIT)
ABILITIES :
- Motivated and result oriented with good communication skills.
- Good analytical abilities and Zeal for learning new things.
- Willingness and ability to adapt the changing situations
SKILLS :
- Investigate complex cases or system related issues occurring within the process and determine appropriate course of action, if required seeking assistance from Clients.
- Collating monthly errors that are committed by the associates and reporting it to management for process improvement.
- Ensuring that all daily work is performed within the procedural guidelines.
- Implementation of the best practices all over the process as and when required.
- Taking initiatives in developing process knowledge among the team members by conducting sessions or preparing presentations for easy understanding.
- Researching the policies and procedure of the process and updating the team about the changes and improvements.
- Motivating the Team Members in achieving their daily targets.
- Handling team in the absence of Supervisor.
WORK EXPERIENCE :
- Working as Senior AR Analyst (ACCOUNTS RECEIVABLE) in PHYCARE SERVICES INDIA PVT LTD from Jan 2011 to till date.
- Worked as Senior Process Associate (CASH POSTING) in PHYCARE SERVICES INDIA PVT LTD from Jan 2010 to Dec 2010.
- Worked as Senior Process Associate/Team Coordinator (CHARGE POSTING) in PHYCARE SERVICES INDIA PVT LTD from Dec 2006 to Dec 2009.
JOB PROFILE :
1) Registration of patients – Manual Interface
2) Charge Posting :
Multiple Specialties - OB-Deliveries, Surgery, Anesthesia, Neurology, Nephrology, Cardiology, Pathology, Radiology, Gastroenterology, Endocrinology, Pulmonary, Rehabilitation Medicine, Internal Medicine and many more.
3) Payment Posting – Manual Interface
4) Denial Management :
Working on Front end rejections, denials - analyze accounts and healthcare data - communicate via website with insurance companies - understand payment cycles -resolve unpaid/partially paid insurance balances-verify patient insurance eligibility and benefits-work with multiple software systems. Paper claims submission (Corrected claims, W9 and State license, Medical records, Anesthesia reports) and getting the claims paid for Medicare, Medicaid and Commercial plans.
5) Provider Data Updates
6) Project Based Adjustments and Write-off
WORK ENVIRONMENT :
1) IDX
2) MEDISOFT

[Guest]

Curriculum Vitae
Name Full Syed. Habibullah
Designation Team Lead
Company Cognizant Technology Solutions, Hyderabad,
India.
Email id : syedhabib26 AT gmail.com , syedhabib26 AT yahoo.in
Educational details :
Course Year of Passing Subject / Specialization Institution / University
MSc. 2002 Applied Microbiology Periyaar University, Salem (T.N)
Summary :
I am currently working with Cognizant Technology Solutions as a Team lead.
I have 9 years of total professional experience. And I have 6.5 years of rich experience in Clinical Data Management. I have keen interest in exploring new technologies and implementing them for the best interest of the Organization.
Overall Therapeutic areas worked :
Worked on PhaseI-Phase 4 studies. I have overall project management experience. Worked on Therapeutic areas like Oncology, Women’s health, Endocrinology, Cardiology and Neuroscience.
I’m very good in planning and communicating with the team. I am self confident, self-learning and hard working. I possess strong leadership qualities, presentation skills Interpersonal skills. Positive attitude, Planning, Patience and Determination are my strengths.
Work Experience :
1)Company : Cognizant technology solutions: (April 2011 till date)
Designation : Team lead

Job Role :
- Lead and coordinate the day-to-day activities of the team (15 Nos)
- Perform data management activities for assigned projects and studies
SCOPE OF CONTROL :
- Junior Data Analyst.
- Data Analyst.
OPERATIONAL RESPONSIBILITY :
Technical
- Coordination of all the Data Management activities
- Review and provide inputs to study/project documents
- Perform data management activities on assigned projects
- Ensure timely and high quality delivery of data management deliverables
- Provide status reports to the client, internal management as required
- Participate in study team meetings, taking presentations.
- Archive all necessary information/documents for audit/inspections purpose
- Ensure compliance to applicable SOPs
- Support QC/QA processes on the project

Supervisory responsibilities
- Tracking and approving leaves for team members
- Resignations / Abscond communication to Project Manager
- Ensuring timely submission of timesheets/ functional tracking spreadsheets by the team members.
- Timely Metrics capture and reporting
- Mentoring Team members. Taking presentations of project related activities.
- Contributing to the organization structure as and when required
- People management and resource/work allocation across projects.
- Provide regular feedback to team members and conduct appraisals
- Ensure completion of training records for all direct reports
- Support multiple clinical trials, across diverse therapeutic areas, to successful conclusion and provide technical oversight when required
- Responsible for overall quality of deliverables from the team.
- Ensure compliance and Audit readiness among the team members
- Ensure appropriate distribution of work among direct reports
- Help team members to enhance soft skills such as presentation skills, communication skills etc
- Participate in knowledge sharing sessions as an when applicable
- Handling team concerns, encouraging the team at work.
- Providing the feedback to the team members
- Maintaining study issues in issue tracker, attending study team meetings to provide updates to onshore DM team.
- Attending Video conferences with the leads to discuss team issues with Cognizant Project manager.
- Conducting regular team meetings to listen to team members concerns and providing resolutions and ideas to settle issues.
- Completing SOPs in time and ensuring team members to be compliant with all SOPs.
- Ensuring all the team members to attend scheduled trainings, maintaining training folders, and to ensure weekly Time sheet update.
2)Company : United Health Group Information Services - I3 statprobe (June 2009 to Apr 2011 )
Designation : Clinical Data Manager
- Managing(mentoring and assigning various tasks on daily basis) a group of 20 members on a project as Lead and POC for the study for all DM activities handling all the onshore calls/meetings.
- Carry out validation procedure testing and provide feedback to the clinical database programmers.
- Working on Data Validation ie Discrepancy management in EDC studies (Inform) and Paper based studies (Clintrial).
- Responsible for 3 Studies(Oncology,Endocrinology and Neurology) for Data validation as Validation Lead.
- Worked on Lab data (as a Lab specialist) running different reports through I-review for 13 studies and sending issues to the Vendors for resolution and requesting for correct update of GLS (Generic Laboratory system) data maintained by the Third party.
- Creates , reviews and processes Data Clarification Forms and updates the database.
- Running Validation Log for errors. Sometimes running validation manually.
- Running Coding Log for uncoded terms.
- Performs other miscellaneous activities along with QC of database, Data Management processes and documentation as required.
- Regularly liaises with monitoring database programming, medical coding and statistical programming teams to ensure smooth functioning of a study.
- Performing SAE review and Manual review of CRF data (paper studies) and reconciliation of SAEs for both Inform(EDC ) and Clintrial (Paper) studies.
- Performing reconciliation of laboratory or any external (third party) vendor data.
- Proposes alternatives and solutions for improvement in quality of work.
- Sometimes providing trial progress reports to Clients.
- Involves in Interactive coding for Uncoded Medications. Running reports for uncoded Adverse events.
- Attended Client audits for many studies. Providing presentations to the Clients using MS excel and Powepoint.
- Received many times appreciations from Onshore team for my good performance and project management skills
- Received performance awards.
3)Company : Reliance Clinical Research Services Pvt. Ltd. (3rd April 2007 to January 2009)
Designation : Clinical Data Coordinator- 2
Job Profile :
- All CDM activities like data validation, generating DCFs, Attending Telecons from Project managers to give study updates, preparing CRF filling guidelines, Global rulings,
- Discrepancy management.
- Preparing Edit checks .
- Preparing Annotated CRFs.
- Preparing Dirty patients and clean patient for Testing of Edit checks.
- Performing SAE reconciliation between Oracle clinical database and Safety database maintained by Pharmacovigilance department to remove the inconsistency of data .
- Performing QC of data before database lock.
- Lab data reconciliation.
- Medical Coding using MedDRA and WHO Drug dictionaries.
- Undergone Oracle clinical Training in RCRS for 1 Week. From DBMS Consulting corporation at Reliance.
4)Company : Accenture Services (P) Ltd, Bangalore. ( 28th Mar 2005 to 30th Mar 2007)
Designation : Certified Data Validation Associate (CDVA)
Job Profile :
- Ensures the completeness and validity of the Clinical trial data that has gone through
data entry.

- Review and Resolve discrepancies identified by the system or through manual checks as per guidelines.
- Generate and review Case Report Form summary report and track missing CRFs.
- Issue Data Clarification Forms to clinical trial sites.
- Perform database quality reviews documenting findings for use in assessing the quality index.
- Review, perform checks on the lab data
- Review all discrepancies set to Lab review and provide solutions.
- Collaborate with validation team to raise awareness and skill of the team in
handling Lab data & provide support to update guidelines used to edit lab data.
- Ensure accurate application of validation guidelines referencing
Global Thesaurus Management Team (GTMT) guidelines.
- Review the handling of uncoded terms edited by DVAs across therapeutic areas. This includes terms set to TMS evaluation, queries written and integration of
DCFs for coding.
- Provide feedback to Leads for quality and efficiency improvement
and ensure necessary corrective measures are taken.
- Accountable for providing updates to the Therapeutic lead and for
assisting the Therapeutic lead in making changes in the way in which
study work is performed. Ensure efficiency of operations.
- Responsible for attaining and maintaining high quality
(client acceptance) deliverables with efficient application of resource.
- Ensure timelines set by the client are met.
- Received many times performance awards.

4)Company : Immunoshop Diagnostics Private Limited, CBD Belapur, Navi Mumbai. (July 2003 to December 2004)
Designation : Marketing executive, Exp: 1.5 yrs
Job Location : Bangalore.
Job profile :
- Selling/marketing the research /laboratory diagnostic kits like all kinds of proteins for assays, laboratory chemicals, monoclonal, polyclonal antibodies, enzymes to research labs like Aurigene, Biocon, SAMI labs and hospitals.
- Meeting the doctors/pathologists at hospitals like Sagar Apollo, Manipal hospital, Wockhardt hospitals and convincing them about the quality of the products and explaining them about the kits that can be used to diagnose/analyse the protein levels in serum with high precision and accuracy.
- Giving live demonstrations about how a diagnostic kit works and running the assay if necessary on Semi autoanalysers, ELISA readers, Gamma counters(Radio immuno assays) and explaining about how to interprete the results accurately as per Instruction booklet provided with the kits.
5). Company : Institute of Transfusion Medicine and Research (ITMR), Hyderabad worked from May 2002 to June 2003.
Designation : Microbiologist
Job profile :
- Preparation of all kinds of Laboratory Medias for Bacterial and Fungal cultures.
- Handling blood cultures, fungal cultures, bacterial cultures performing sensitivity tests to identify bacteria in different specimens like blood, sputum, pus, urine, csf etc.
- Trained on blood drawing techniques.
- Performing all kinds of bacterial/fungal staining and identification techniques.
- Worked on Semi autoanalysers and ELISA readers for analyzing different protein/hormone(like anti HBs Ag, anti TB etc) levels in serum.
- Got well trained in performing HIV lab tests- CD4/CD8 cell estimation in whole blood samples in active AIDS patients who are under treatment.
- Performing all kinds of biochemical techniques like hormonal assays(like T3,T4,TSH etc) on BIOTRON Semi autoanalysers..
Skills & Knowledge:
- Pharma Basics: Research
- Pharma Basics: Pre Clinical
- Pharma Basics: Clinical Development and Regulatory act.
- Standard operating procedures for Clinical Data Management
- Basic knowledge of Good Clinical Practice & International Conference
on Harmonization.
- Basic knowledge of Pharma Regulatory Affairs in Clinical Research.
- Good technical knowledge of the process of Clinical Data Management.
- Strong interpersonal skills within the team.
- Proactive.
- Analytical approach.

Software Skills :
Oracle Clinical 4.5.1
CDRS (Clinical data review system)
Discrepancy Tool set
RDC(Remote data capture) platform
EDC (Electronic data capture)studies :
Tool: Inform ver 4.5 and Clintrial systems.
I-review( Integrated Review system)
J review.
Ms-Office ,
C programming Language.
Typing speed: 40 words/minute