Pethukumaran Sivabalajothy
Chennai
Summary
A dynamic professional with over 17+ years of rich experience in Operations Management, Process Management, Client Relationship Management, Training and Team Management in RCM Process.
In-depth knowledge of Revenue Cycle Management (Accounts Receivable, Denial Management, Claim Rejections, Payment Posting & Charge Entry) and fair knowledge on Credentialing & Contracting Process.
Went Onsite to Meet End Client and helped them to simplify & sort out their front end Process. Visit also includes New Project Transition.
Managing process operations with key focus on meeting SLA's and optimal utilization of resources; result oriented record of streamlining the process flow & SOP's for enhanced operational effectiveness.
Proven skills in managing teams to work in sync with the corporate set parameters & motivating them for achieving individual and business goals.
Possess excellent interpersonal and organizational skills with proven abilities in team management, planning and mentoring.
Thorough professional with a proactive attitude, capable of thinking in and out of the box, generating new solutions and ideas
Overview
19
19
years of professional experience
Work History
Senior Manager - Delivery
Omega Healthcare
01.2022 - Current
- Handling RCM Process (Multi Specialty) with total team strength of 250+ members.
- Accomplished multiple tasks within established timeframes.
- Maintained Multiple SLA's within Client's TAT.
- Governed employee performance tracker for all Leads and ensure agents are working at their optimum level in terms of productivity, quality and planning continuous improvement.
- Monitoring overall functioning of process, identifying improvement areas and implementing adequate measures to maximize customer satisfaction level.
- Forecasting workload and scheduling staff to meet anticipated workload thereby enhancing efficiency.
- Identifying training needs and ensuring required training is imparted.
- Motivate team to achieve desired Quality and Production targets.
- Managed resources effectively to avoid unnecessary delivery delays.
Delivery Manager - AR
Access Healthcare Services Private Limited
03.2021 - 10.2021
- Handled Athena AR process with total team strength of 160+ members.
- Monitoring overall functioning of process, identifying improvement areas and implementing adequate measures to maximize customer satisfaction level.
- Maintained employee performance tracker for all Leads and ensure agents are working at their optimum level in terms of productivity, quality and planning continuous improvement.
Manager RCM Services
Visionary RCM Infotech
04.2017 - 09.2020
- Handled complete Revenue Cycle Management processes with total team strength of 80+ members.
- Pre-Auth processes with 60+ members for client network based in Missouri, Kentucky, Kansas, Florida.
- Processed 4000 Patient charts on daily basis for Pre Authorization which includes current day walk-ins both thru Online and Calling.
- Ensuring all clauses in SLA are met in terms of productivity, accuracy and efficiency month-on-month
- Monitoring overall functioning of process, identifying improvement areas and implementing adequate measures to maximize customer satisfaction level.
- Forecasting workload and scheduling staff to meet anticipated workload thereby enhancing efficiency
- Identifying training needs and ensuring required training is imparted.
- Interacting with client through E-mails and Calls when required to review/ resolve operational issues as well as implement new process & procedure changes
- Creating and sustaining highly motivated and energetic work environment through effective team management
- Identifying & implementing strategies for building team effectiveness by promoting a spirit of cooperation amongst team members
- Reviewing, evaluating and updating Standard Operating Procedures of process as needed and communicating changes/inclusions to client.
- Create MIS reports (Work Load Analysis, Time Analysis, Resource Allocation, Weekly and Monthly Reports, Ops report, Executive Summary etc.,) as requested by client and Top Management.
Sr. Account Manager
Visionary RCM
09.2012 - 03.2017
- Played major role on Operations management for 140+ member end-to-end Provider RCM Operations Process.
- Guiding team on focus areas on day-to-day basis.
- Provided individual and team training on account receivables, insurance products and innovative techniques.
- Found new avenues in minimizing AR overheads such as online claims status, eligibility and submitting claims through online etc.
- Technical expertise to minimize complexities in day-to-day processes through systemizing tasks.
- Calculating AR days for Provider Practice/Group by following standard practices. Assisting AR team in running different types of AR reports based on different parameters & focusing on Old AR (which is over 90+ days based on the priority).
Account Manager
Visionary RCM
04.2010 - 08.2012
- Played major role on Operations management for 40+ member end-to-end Provider RCM Operations Process.
- Preparation of Management Reports and Client Requests
- Preparation of Client Invoices.
- Innovate to optimize production and constantly improve Production, Quality and Turnaround Time and updating client SOP periodically.
- Report issues pending with client & follow up till they are resolved.
- Responsible for financial reporting for client's monthly analysis and productivity reports.
- Designed and implemented strict QA guidelines for charges & cash posting to enable "clean claims" and speedy AR recovery.
Team Lead - Operations
Visionary RCM
04.2009 - 04.2010
- In charge of 15 member team and auditing their daily work.
- Ensuring all clauses in SLA is met in terms of productivity, accuracy and efficiency month-on-month.
- Allocation of work order to ARE's & SME's on a daily basis.
Quality Controller
Visionary RCM
07.2008 - 03.2009
- Managed quality documentation and participated in internal and external quality audits.
- Followed quality standards and procedures to minimize errors and maximize customer satisfaction.
- Updated quality control standards, methods and procedures to meet compliance requirements.
- Provided observations, took measurements and performed tests at various stages according to quality control plan.
Transaction Process Executive
Visionary RCM
07.2007 - 06.2008
- Worked for Multi-Specialty Client on all LOB's of US Healthcare RCM Process. Starting from Charges to Accounts Receivable & Appeals.
Transaction Processing Executive
Ivory Business Solutions
05.2006 - 12.2006
- Charges and Payments Entry & Audit.
Claims Processing Executive
Nittany Outsourcing Services
12.2004 - 03.2006
- ·Patient Demographic, Charges and Payments Entry.
Education
Bachelor of Arts - Corporate Secretaryship
University Of Madras
Chennai, TN07.2002
Skills
- Industry Knowledge
- Strategic Decision-Making
- Organizational & Leadership
- Critical & Quick Thinking
- Ethical Judgment
- Adaptability
- Empathy
Onsite Visit History
- San Luis Obispo, California (Sep 2014 to Dec 2014)
New Client Transition.
To Streamline & Simplify Daily Process with VRCM Employees in US.
Shared and discussed about the achievements done by us with the Client.
Prepared and Delivered Reports requested by Client during Board Meetings.
- Ballwin, Missouri (Nov 2017)
New Client Transition.
Specialty Expertise
- Ambulatory Service Center Billing
- Physician Billing (Multi specialty)
- Hospital Billing
- Optometry Benefits Authorization
- Credentialing & Contracting
Timeline
Senior Manager - Delivery
Omega Healthcare
01.2022 - Current
Delivery Manager - AR
Access Healthcare Services Private Limited
03.2021 - 10.2021
Manager RCM Services
Visionary RCM Infotech
04.2017 - 09.2020
Sr. Account Manager
Visionary RCM
09.2012 - 03.2017
Account Manager
Visionary RCM
04.2010 - 08.2012
Team Lead - Operations
Visionary RCM
04.2009 - 04.2010
Quality Controller
Visionary RCM
07.2008 - 03.2009
Transaction Process Executive
Visionary RCM
07.2007 - 06.2008
Transaction Processing Executive
Ivory Business Solutions
05.2006 - 12.2006
Claims Processing Executive
Nittany Outsourcing Services
12.2004 - 03.2006
Bachelor of Arts - Corporate Secretaryship
University Of Madras
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