Vijith Rajeev

Experienced Revenue Cycle Management (RCM) professional with over 15 years of experience in the healthcare industry. Proven ability to establish, implement, and optimize revenue cycle processes to ensure seamless financial operations and maximize collections. Skilled in all aspects of RCM, including contracting with payers, claims processing and adjudication, stakeholder management, denial management and HIS developments.

Adept at utilizing technology to improve workflow efficiency and reduce claim rejections. Strong leadership and communication skills with a successful track record of building and motivating teams.

Sr Manager RCM - Royal Medical Center & One Day Surgery

(2023-06)

• Led the establishment of revenue cycle management (RCM) processes and infrastructure for the new medical facility, ensuring seamless financial operations from launch
• Implementing robust data analytics and performance tracking systems to proactively identify revenue cycle trends and opportunities for process improvement.
• Leveraging years of healthcare revenue cycle expertise to develop and implement strategic initiatives for the new medical facility, specifically optimizing revenue capture and operational efficiency
• Provides training and education to clinical, clerical, and professional staff regarding accurate and appropriate charge capturing.
• Administrating claim -submission, and denial management processes to maximize clean claim rates and minimize denials, and conducting regular audits to ensure compliance with healthcare billing regulations.
• Collaborating with IT and finance departments to optimize revenue cycle systems and workflows, and analyzing financial data to identify areas for cost reduction and revenue growth
• Providing ongoing analysis and reporting to senior management and physicians on revenue cycle performance including revenue lost opportunities for corrective actions.
• Manages department communication and education of charge capture related workflows, including identified changes in processes, structures, or systems/functionality.
• Managed all aspects of the revenue cycle for insured patients, from initial registration to accurate claim adjudication, including: contracting with insurance companies, credentialing and registration, charge master., claimsprocessing and submission management, and denials reporting.
• Supervised the development, implementation, and maintenance of standardized revenue cycle operating procedures, ensuring efficient patient billing
• Promoted best practices in automation and workflow management used for claim submission, and conducted regular meetings with all ICs to maintain ongoing smooth business relations.
• Scheduled, assigned, and prioritized department workload, and conducted staff and one-on-one meetings to facilitate attainment of both revenue cycle and employee goals
• Ensured claims submission in line with DOH/DHA claims adjudication rules & validation requirements, also monitored aged accounts, and verified appropriate collections procedures were being followed
• Led and mentored a team of billing staff, providing new hire orientation, cross-training opportunities, and ongoing training for all staff and physicians involved in the revenue cycle
• Coordinated with Information Technology to integrate billing requirements to reduce rejections and maximize collections, also maintained the quality of submitted claims to achieve targeted recovery rates and reasonable rejection rates
• Developed and implemented progressive short-term goals that align with the company's vision and business goals, also accurately assessed strengths and development needs of employees and provided timely, specific feedback and coaching.
• Identifying system billing errors and coordinating with IT to fix them permanently to ensure faster claims submission.
• Monitoring submission and quality of high value claims to avoid payer rejections.
• Monthly meeting the with senior management on unbilled claims to resolve the documentation and admin queries raised by RCM.
• Supporting IT team on enhancing the HIS based on any change in ClaimsAdjudication rule by health regulatory.
• Reviewing generation of invoice and claim submission of self-pay and corporate claims.
• Monthly meeting payers on FDRG revision pending approvals to close submission within stipulated timelines

Insurance Manager - Burjeel - VPS

(2016-10 - 2023-06)

• Accomplished the measuring progress against departmental and unit-specific goals, and led the development and implementation of the unit's insurance strategy
• Nurtured a strong organizational culture by establishing quality awareness, service orientation, and implementing Project Management and Change Management processes
• Evaluated disallowance reasons, identified improvement areas, and implemented corrective actions
• Reviewed, investigated, and responded to claims appeals and grievances, ensuring fair and consistent resolutions
• Supervised claim adjudication decision-making to guarantee adherence to established guidelines and processes
• Prepared the department for successful completion of audits (Insurance, Tasneef, etc.) through comprehensive documentation and timely communication
• Reviewing unique services claims like Bone Marrow Transplant, Organ Transplant and Cochlear Implant cases prior submission
• Achieved the OP/IP approval process, including follow-up and successful negotiation of difficult approvals.

Billing Supervisor - Burjeel Hospital

(2013-11 - 2016-10)

• Assisted the Revenue Operations Manager in workload management to achieve departmental goals within agreed-upon quality standards
• Collaborated with the Manager to develop and implement procedures that improved departmental efficiency and operational quality
• Certified the RCM team followed proper revenue cycle procedures aligned with Department of Health (DOH)/Dubai Health Authority (DHA) adjudication rules and Standard Performance Criteria (SPC)
• Maintained positive relationships with healthcare providers and payers to resolve billing issues and ensure smooth claims processing.

Sr.Billing Executive - Burjeel Hospital - Abu Dhabi

(2012-05 - 2013-11)

Billing Coordinator - NMC Specialty Hospital - Abu Dhabi

(2009-01 - 2012-03)

Tech Support Specialist/Help Desk - Convergys - India

(2007-04 - 2008-12)

Bachelor of Business Administration

Bachelor of Technology - Electronics and Communication