Shyam Sai

• Analyse the rejected/denied claims and understand the reasons of rejections/denial and reprocess the same for payment
• Responsible for working on Denials, Rejections, making required corrections to claims
• Calling the insurance carrier & Document the actions taken in claims billing summary notes.
• Led high-performing teams, training, and developing professionals for growth and success.
• Conducted regular performance reviews to identify growth opportunities, areas for improvement, and training needs.
• Provided insights and recommendations as a acting subject matter expert
• Consistently delivered high-quality services, ensuring zero financial penalties and high customer satisfaction.
• Successfully managed client relationships, engaging stakeholders and meeting their needs and expectations.

➢ Performed Credentialing and Re-Credentialing for Medical, Behavioural healthcare practitioners & Practitioner Onboarding.

➢ Highly accountable for maintaining compliance and TAT metrics

➢ Helped new hires and cross trained processors until Ramp completion.

➢ Review and assign audit files to the entire team.

➢ Conduct audit training for the new auditors

➢ Collate Quality audit results and share MTD scores to the team

➢ Part of client calls for updates and refutes

➢ Responsible for calculating and maintaining TAT

➢ Review defects and provide feedback to the processors

➢ Responsible for doing Root cause and 5 Why analysis

➢ Prepare and Conduct Process knowledge test

➢ Create Quality and PKT dashboards.