Dr Praseeda Binesh

• Insurance Network Management: Established and maintained relationships with insurance providers, leading negotiations to expand the provider network and secure favorable terms for the organization.
• Claims Processing Oversight: Directed the end-to-end claims processing cycle, ensuring compliance with industry standards, accurate medical coding, and efficient submission to insurance companies.
• Audit Leadership: Coordinated internal and external audits, including JAWDA-TASNEEF audits, ensuring full regulatory compliance and improving operational efficiencies.
• Revenue Cycle Optimization: Spearheaded initiatives to streamline revenue cycle processes, enhancing billing and coding accuracy while reducing claim rejection rates.
• Denial Management: Implemented effective strategies for managing claim denials, identifying trends, and optimizing resubmission processes to improve reimbursement outcomes.
• Medical Coding Supervision: Led a team of 23 medical coders, ensuring adherence to ICD-10-CM, CPT, and USCLS coding standards while improving coding accuracy and documentation practices.
• Policy Development: Developed and implemented comprehensive insurance department policies to ensure consistency, compliance, and alignment with organizational goals.
• Prior Authorization Oversight: Directed the prior authorization process to ensure timely approvals for procedures and services, minimizing delays in claims processing.
• Team Leadership and Development: Trained and mentored staff in best practices for coding, billing, and claims management, fostering a high-performing and efficient team.
• Data Analysis and Reporting: Utilized advanced Microsoft Excel skills to create detailed reports on claims performance, denial trends, and financial outcomes, supporting data-driven decision-making.