Nand Gopal Pandey

Performance-driven RCM Leader with 5+ years of expertise in end-to-end US Healthcare Accounts Receivable and Revenue Recovery, with comprehensive experience handling medical, dental, and vision claims. Specialized in managing complex inventory, leading Subject Matter Expert (SME) teams, and driving SLA excellence. Proven ability to stabilize new client transitions, reduce Days Sales Outstanding (DSO), and improve Net Collection Rates (NCR) through data-driven auditing and process re-engineering.

Subject Matter Expert (SME) - ARS Medical Billing

(2024-10 - 2026-05)

• Successfully spearheaded the AR stabilization for a high-volume hospital client, improving initial collection velocity by 22% within the first quarter.
• Developed a customized workflow for patient/guarantor outreach that reduced Coordination of Benefits (COB) denials by 30%.
• Implemented a "Coding-to-Collection" feedback loop using the Codify tool, reducing recurring medical necessity denials.
• Oversaw daily inventory distribution and workflow prioritization for a team of specialists to ensure 100% adherence to client-specific SLAs.

Quality Analyst (QA) - Neolytix

(2024-01 - 2024-09)

• Managed end-to-end quality audits for diverse AR portfolios, identifying revenue leakage points that saved an estimated $50k+ in monthly potential write-offs.
• Engineered and delivered training modules for new hires, reducing the learning curve by 2 weeks and improving floor accuracy scores from 85% to 96%.
• Acted as a bridge between operations and senior management, producing data-driven reports on payer trends and agent productivity.

Senior Executive - Pacific BPO Pvt. Ltd.

(2021-02 - 2023-11)

• Managed high-complexity medical, dental, and vision claims within Epic and SSI, ensuring zero-error resolution of EDI rejections and clearinghouse front-end edits.
• Managed end-to-end dental billing operations utilizing Dentrix software, streamlining claim submissions, tracking pre-determinations, and executing targeted follow-up on dental denials to secure timely reimbursement.
• Led a task force focused on challenging "Bundled" and "Non-Covered" denials with major US payers (Aetna, BCBS, United Healthcare), achieving a 40% reversal rate.
• Conducted pre-submission audits to ensure all claims met Timely Filing Limits (TFL) and authorization requirements.

AR Analyst - R1 RCM

(2020-03 - 2021-02)

• Managed a high-dollar inventory for Medicaid and Commercial payers across medical, dental, and vision specialties, consistently maintaining a 98% quality accuracy rating.
• Successfully appealed aged claims (120+ days), recovering significant revenue previously deemed uncollectible.

M.Com - IGNOU

B.Com - University of Delhi (2019)