Vincent Jebaraj
Dubai
Summary
Talented Manager with expert team leadership, planning, and organizational skills built during successful career. Smoothly equip employees to independently handle daily functions and meet customer needs. Diligent trainer and mentor with exceptional management abilities and results-driven approach.
Overview
16
16
years of professional experience
Work History
Manager- Claims & Provider Audit
Whealth International TPA LLC
01.2019 - 03.2022
- Managed claims adjudication of ALL providers claims for the TPA
- Managed the provider audits and submitted FWA report to Regulators quarterly
- Supported on approval issues, service excellence and handling member grievances
- Report burning ratio, profit, or loss ratio of each member group to the management and suggested process amendments to control burning and loss of a policy group
- Supported on underwriting of new policies for high burning groups
- Served as helpful employee for all departments.
Assistant Manager- Networking & Claims
Maxcare TPA
08.2017 - 12.2018
- Created employee schedules to align coverage with forecasted demands
- Helped with planning schedules and delegating assignments to meet coverage and service demands
- Developed loyal and highly satisfied customer base through proactive management of team customer service strategies
- Networking with providers across UAE & Oman
- Medical file audits with providers & interacting with brokers & insurers.
Account Receivable Executive
NMC Speciality Hospital
04.2015 - 07.2017
- Taking pre-approval from payers by picking the right ICD & CPT
- Audit OP & IP claims to make sure clean claims are submitted
- Making sure submissions are done on time without passing on the filing limit
- Making sure RA's are posted and rejected claims are resubmitted to appropriate payers.
Team Leader- Account Receivables
Omega Healthcare Pvt. Ltd.
11.2012 - 06.2014
- Handled a team of 48 members and allocated daily work orders
- Preparation of AR, denial & rejection reports daily, assigning them to specific users
- Performed regular audits on completed work
- Handled physician credentialing and patient calling
- Negotiating with payers on Multi-plan contracts
- Per user revenue report presented to management on a weekly basis.
Team Leader- Account Receivables
Visionary RCM Pvt. Ltd.
09.2011 - 08.2012
- Handled a team of 12 members
- Analyzing of the aging reports and allocate work orders
- Handled entire Denial management process of the team.
Team Leader - Account Recievables
Itech India Pvt. Ltd.
02.2009 - 08.2011
- Created a team of 11 members for this startup company and involved in bringing new projects
- Managed and transitioned the accounts receivables projects successfully
- Preparation of weekly, monthly & quarterly reports for the management on a per user basis.
Team Leader - Account Recievables
Sysinformation Healthcare Pvt. Ltd.
01.2006 - 01.2009
- Joined as an AR caller and within a short span of time was promoted to be a Senior AR Executive
- A Certificate of Excellence was awarded to our team for 2007-08.
Education
Bachelors of Commerce - Commerce
Annamalai University
Tamil Nadu, Tamil Nadu06.1995
Skills
- Revenue Cycle Management
- Efficient Revenue Cycle Manager
- Procedure Optimization
- Revenue Metrics Analysis
- Account Monitoring
- Financial Performance
- Violation Identification
- Capitation Model
- Financial Transactions
- Fraudulent Transaction Identification
- False Claims Control
- Malpractice Identification
- Onsite Audit
- Claims Analysis
- Premium Collection
- Policy Group Management
- Underwriting
- Customer Service
- Networking
- Medical File Audits
- Broker & Insurer Interaction
- Pre-Approval
- Clean Claims Submission
- Timely Submissions
- RA Posting
- Rejected Claims Resubmission
- Team Management
- AR, Denial & Rejection Reports
- Physician Credentialing
- Patient Calling
- Payer Negotiation
- Multi-Plan Contracts
- Aging Reports Analysis
- Denial Management
- Project Management
Languages
English
Tamil
Hindi
Timeline
Manager- Claims & Provider Audit
Whealth International TPA LLC
01.2019 - 03.2022
Assistant Manager- Networking & Claims
Maxcare TPA
08.2017 - 12.2018
Account Receivable Executive
NMC Speciality Hospital
04.2015 - 07.2017
Team Leader- Account Receivables
Omega Healthcare Pvt. Ltd.
11.2012 - 06.2014
Team Leader- Account Receivables
Visionary RCM Pvt. Ltd.
09.2011 - 08.2012
Team Leader - Account Recievables
Itech India Pvt. Ltd.
02.2009 - 08.2011
Team Leader - Account Recievables
Sysinformation Healthcare Pvt. Ltd.
01.2006 - 01.2009
Bachelors of Commerce - Commerce
Annamalai University
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