Keloth Raju
Healthcare Quality Assurance Specialist
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About
Results-driven Healthcare Quality Assurance Specialist with 7+ years of experience in Revenue Cycle Management (RCM), Accounts Receivable (AR), and Denial Management. Expertise in driving quality improvements through Root Cause Analysis (RCA), reducing defects, and enhancing operational efficiency. Proven ability in audits, client calibration, compliance adherence, and team development. Strong analytical mindset with a focus on data-driven decision-making and continuous process improvement.
Experience
QUALITY EXPERT - IKS HEALTHCARE PVT. LTD. - Hyderabad
(2025-12)
- Perform end-to-end quality audits across RCM lifecycle (Demographics → Denials → Appeals)
- Conduct Root Cause Analysis (RCA) to identify error trends and implement corrective actions
- Improve first-pass accuracy and AR quality metrics through structured interventions
- Lead training sessions, refreshers, and knowledge-sharing programs
- Perform client calibration, blind scoring, and quality alignment activities
- Ensure compliance with SOPs, SLAs, and regulatory standards
- Collaborate with leadership to enhance operational performance and quality scores
- Develop dashboards and KPI reports to track quality and productivity trends
- Act as backup QA/Operations Team Lead
- Prepare daily/weekly/monthly QA reports (accuracy trends, defects, performance gaps)
- Build KPI dashboards (Accuracy %, Compliance %, AR Days, Denial Trends, Productivity)
- Present data-driven insights to Operations & Client stakeholders
- Analyze rework cost & productivity loss, recommend preventive actions
SENIOR AR ASSOCIATE / QA SUPPORT - R1 RCM PVT. LTD. - Hyderabad
(2022-10 - 2025-12)
- Managed Hospital Billing (HB) & Professional Billing (PB) workflows
- Performed trend analysis and RCA on quality defects
- Resolved denied, unpaid, and aged claims effectively
- Interpreted EOBs and corrected claim discrepancies
- Delivered on-the-job training and performance feedback
- Supported QA team with process clarifications and audit readiness
- Reduced AR aging and improved collections efficiency
- Handled complex denials (coding, eligibility, authorization)
- Assisted new hires with tool navigation & portal setup
- Conducted daily quality meetings & audit reporting
- Tracked AR days, collections performance, and write-off trends
SENIOR PROCESS ASSOCIATE - EPICLE SOLUTIONS PVT. LTD. - Hyderabad
(2021-12 - 2022-09)
- Managed EDI rejections and claim corrections via Trizetto
- Executed AR follow-ups and denial management processes
- Handled claims across Medicare, Medicaid, and Commercial payers
- Delivered performance reports and business presentations
- Contributed to process improvements and operational best practices
SENIOR PROCESS ASSOCIATE (AR) - VCARVE RCM PVT. LTD. - Hyderabad
(2018-03 - 2021-03)
- Processed 65–100+ accounts daily for AR follow-ups
- Verified insurance eligibility via portals and calls
- Identified denial trends and escalated critical issues
- Managed billing, payment posting, and adjustments
- Ensured HIPAA compliance and data accuracy
- Improved cash flow and reduced AR days significantly
- Worked extensively on CMS-1500 claim processing
Education
M.Tech - Computer Science Engineering (2016)
B.Tech - Computer Science Engineering (2014)
