Present Process: Child PDM (VIANT-OEC)
Designation : Process Associate.
Company Profile: Apollo Health Street, a global Healthcare services company of the Apollo group
offers Business Process Outsourcing and IT solutions and services to a global client. Now it is
merged with southern land Inc.
Roles & Responsibilities:
* Worked on Provider Data Management.Maintaining providers Demographic information,Provider
contracts and network affiliations. Assigning the network to the provider to get paid.
* Network integration & Analysis/Updation of Network Reimbursement Plan - To maintain single
source for provider reimbursement information.
* Worked on Provider Data Correction - Including Name , Address based on ancillary matching,
State, Name, Address (State) , Specialty.
* Verifying Address based on zip by validating in USPS ( United States Postal Service).Verifying
the provider details names and name changes based on SSN,EIN( Employer Identification
Number),NPI ,UPIN (Unique physician/Provider Identification Number ).Verifying NPI ( National
Provider Identifier ) in NPPES -NPI Registry (National Plan and Provider Enumeration
System).Verifying UPIN in upin.ecare.com.
* Finding National Ancillaries. Claims matching and network assigning based on provider name and
address match. Responsible for Data review, Analysis, Correction and maintenance, facilitating
the timely and accurate processing of all Physician agreements for claim payment.
* Assigning Provider to Network.
* Worked on Claims.
* Maintaining Providers Demographic information , Providers Contracts and Provider Network
Affiliations so as to create a single record of truth.
* Network integration & Analysis/Updation of Network Reimbursement Plan - To maintain single
source for provider reimbursement information
* Worked on Provider Data Correction - Including Name , Address
* Worked on Assigning network based on ancillary matching.
* Assigning Network to provider Based on State, Name, Address (State) , Specialty.
* Verifying Provider names and name changes.
* Verifying Address based on zip by validating in USPS ( United States Postal Service).
* Verifying the provider details based on SSN,EIN( Employer Identification Number),NPI ,UPIN
(Unique physician/Provider Identification Number ).
* Verifying NPI ( National Provider Identifier ) in NPPES -NPI Registry (National Plan and
Provider Enumeration System).
* Verifying UPIN in upin.ecare.com.
* Finding National Ancillaries.
* Claims matching and network assigning based on provider name and address match.
* Responsible for Data review, Analysis, Correction and maintenance, facilitating the timely and
accurate processing of all Physician agreements for claim payment.
* Trained new Joiners.
* Clearing Doubts act as mentor in the process.
Achievements:
* Took up the challenge of consistently maintaining more productivity than the given target
with 100% accuracy.
* Trained and Mentored new joiners by helping them understand the process and solving their
queries.
* Successfully handling a team of 8 associates as bay leader.
* Playes an important role in auditing & improved the accuracy of the data processed.