Chiru Raja

Results-driven Quality Analyst with 7+ years of experience in US Healthcare Revenue Cycle Management (RCM), specializing in Quality Assurance, Accounts Receivable Management, Denial Management, Claims Resolution, Process Audits, Compliance Monitoring, and Performance Improvement. Proven expertise in conducting quality audits, root cause analysis, quality governance, process enhancement, stakeholder management, and regulatory compliance. Strong knowledge of healthcare billing processes, payer guidelines, HIPAA compliance, insurance claims adjudication, denial prevention, reimbursement recovery, and operational excellence.

Adept at driving quality improvements, increasing process accuracy, reducing operational risks, and supporting organizational performance through data-driven decision-making.

Quality Analyst – Revenue Cycle Management at R1 RCM India Pvt. Ltd. (2024-03 – Present)

Senior Analyst – Revenue Cycle Management at R1 RCM India Pvt. Ltd. (2019-08 – 2024-02)

• Conduct quality audits of healthcare claims and operational transactions to ensure adherence to client standards and HIPAA regulations.
• Analyze audit findings to identify process gaps, quality trends, and recurring error patterns; perform root cause analysis (RCA) and recommend corrective and preventive actions.
• Facilitate calibration sessions with clients, stakeholders, and operations teams to ensure process alignment.
• Evaluate transaction quality, deliver actionable coaching, and provide performance feedback to improve quality metrics and team productivity.
• Generate quality reports, scorecards, and performance dashboards for management review.
• Resolve complex insurance claim denials and reimbursement issues; collaborate with billing and coding teams to improve claim outcomes.

Accounts Receivable Analyst – US Healthcare RCM at ELI Research India Pvt. Ltd. (2016-08 – 2017-07)

• Managed end-to-end Accounts Receivable operations for healthcare clients.
• Conducted claim follow-ups, denial analysis, payment posting reviews, and reimbursement recovery activities.
• Investigated denied and underpaid claims to identify root causes and implement corrective actions.
• Coordinated with insurance carriers for claim resolution and payment recovery.
• Monitored payer trends and denial patterns to improve collection effectiveness.
• Maintained accurate claim documentation and compliance with client requirements, supporting process improvement initiatives to reduce AR aging.

Bachelor of Arts – Motilal Nehru College, University of Delhi (2014)

Higher Secondary Education – Johnstone Higher Secondary School (2011)

Secondary Education – Blue Star Academy (2009)