Jagadeesan Murugesan
Ras Al-Khaimah
Summary
Several years of experience in medical billing (US & UAE). With experience in a variety of roles, I have developed strong interpersonal and people skills. I am capable of working independently, enjoy working in teams, and have excelled as an individual. The combination of my self-motivation and my flexible, outgoing personality allows me to take initiative and communicate effectively at all levels. Each new challenge is met with enthusiasm and vigor as I continue to learn new skills and techniques.
Overview
9
9
years of professional experience
Work History
Claims Management Specialist
Smile Care Medical Center LLC
10.2020 - Current
- Empanelment of insurance companies for both medical and dental services
- Supervision of approvals, claims, and re-conciliation
- Supervision of insurance department training
- Maintaining a regular correspondence with the insurance companies
- Taking responsibility for the department's productivity and targets
- Review denial reasons and audit the claims in order to generate justification for resubmission
- Managing resubmission of denial claims with the standard time frame as per policies and procedure of department
- Discusses the reasons for any rejected approval request with the concerned Doctor/ Nurse or the HOD, to make it materialize into a confirmed approval
- Reconciled account information and reported figures in general ledger by comparing to bank account statement each month.
- Tracked financial progress by creating quarterly and yearly balance sheets.
- Reconciled accounts, managed audits and updated financial records with remarkable accuracy.
Insurance Coordinator (Team Lead)
Ministry of Health Hospital under the contract with QuantMed(Globemed Gulf)
09.2019 - 09.2020
- Managing coordination of all aspects of insurance process which includes pre-approvals, medical billing and invoicing, coding by using CPT and ICD-10-CM code sets
- Conducting Medical Reviews to validate and assure medical record documentation is complete and billed services are justified and compliant as per the patient's health insurance policy
- Maintains strict confidentiality related to medical records and other data
- Obtained data such as patient, insurance ID, insurance provider and medical codes to properly file insurance claims.
- Verified insurance and communicated coverage to staff and patients.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Obtain Prior Approval or Authorization for an Inpatient and Non-Emergency Cases
- Coordinating, Liaising and networking between insurance companies regarding eligibility, payments, approvals, reconciliation and other requirements
- Responsible for filing and tracking insurance claims and informing patients of their claims status
- Process Insurance and disability claims in a timely manner
- Discusses the reasons for any rejected approval request with the concerned Doctor/ Nurse or the HOD, to make it materialize into a confirmed approval
- Filed and tracked insurance claims and communicated claims status to patients.
- Prepared insurance claims for submission to clearinghouses or insurance companies.
Claims Analyst
ONCOSPARK PVT LIMITED
01.2016 - 09.2019
- Maintained strict confidentiality with all personal data as per company guidelines.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Reviewed electronic claims and processes data as required into the claims system
- Timely follow up on claim and appeal submissions
- Obtain necessary documentation from various individuals and groups to provide credence to filed claims
- Any major rejections or denials - clearing carrier and ensure Follow-up on pending claims.
Education
Bachelor of Engineering - Aeronautical
Anna University
01.2015
Skills
- Operations Management
- Reporting & Documentation
- Quality Analysis
- Client Relationship Management
- Team Management
- Microsoft office
- Claims investigation
- Claims analysis
- Claims processing
- Claims resolution
- Claims adjustment
- Denied claims identification
Accomplishments
- In UAE - I worked closely with them post-audit report for Daman and found a way to resolve the lifetime ban from DHA regulators.
- In UAE - successfully enrolled over 10+ insurance companies within two years and have gradually increased our annual revenue by around 40%.
Languages
English
Tamil
Malayalam
Toolssoftwareused
- Riayati
- DHPo
- Unite
Personal Information
- Date of Birth: 06/09/1993
- Marital Status: Married
Disclaimer
I hereby declare that the above mentioned information is true to the best of my knowledge.
Timeline
Claims Management Specialist
Smile Care Medical Center LLC
10.2020 - Current
Insurance Coordinator (Team Lead)
Ministry of Health Hospital under the contract with QuantMed(Globemed Gulf)
09.2019 - 09.2020
Claims Analyst
ONCOSPARK PVT LIMITED
01.2016 - 09.2019
Bachelor of Engineering - Aeronautical
Anna University
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