QUALITY EXPERT at IKS HEALTHCARE PVT. LTD. (2025-12 – Present)
- 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 at R1 RCM PVT. LTD. (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 at EPICLE SOLUTIONS PVT. LTD. (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 EXECUTIVE (AR) at ASCENT BUSINESS SOLUTIONS (2021-04 – 2021-09)
- Reviewed, followed up, and worked on unpaid claims, old claims, no response claims, outstanding claims, and denials
- Demonstrated the ability to read and interpret EOBs, and face sheets from medical facilities
- Created, processed, and submitted claims to various insurance companies electronically, mailed, and or by fax, ensuring their accuracy by contacting patients, health companies or institutions
- Submitted electronic claims and paper claims to primary or secondary insurance
SENIOR PROCESS ASSOCIATE (AR) at VCARVE RCM PVT. LTD. (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
