Quality Analyst – Accounts Receivable (AR) - VISIONARY RCM INFOTECH
(2012-11 - 2015-05)
Specialties: Internal Medicine, Dermatology. Applications: Integreat MED3000, eClinicalWorks, Prime Clinical
- Monitored claim status through insurance portals and direct communication with payers, ensuring timely follow-up and resolution of denied or pending claims.
- Conducted comprehensive quality audits for Charge Entry, Payment Posting, Insurance Accounts Receivable (AR), and Patient AR processes to maintain accuracy, compliance, and service quality.
- Reviewed and processed charge entries and payment postings for hospital claims and CMS-1500 forms in accordance with established standard operating procedures.
- Identified operational and billing issues within assigned practices and escalated concerns to the respective facilities for prompt resolution.
- Prepared and submitted monthly collection reports to healthcare facilities, providing detailed insights into revenue collections and financial performance.
- Ensured adherence to client-specific guidelines, payer regulations, and revenue cycle management best practices to optimize reimbursement outcomes.
Senior AR Caller - ACER HEALTHCARE INDIA PVT. LTD.
(2015-11 - 2017-07)
Specialties: Family Medicine, Internal Medicine, Dermatology, Behavioral Health. Applications: eClinicalWorks, Allscripts, Office Ally
- Followed up on outstanding insurance claims through payer websites and direct communication with insurance representatives to obtain claim status and expedite reimbursements.
- Investigated and resolved claim denials, rejections, underpayments, and payment delays by analyzing payer policies and taking appropriate corrective actions.
- Performed end-to-end quality reviews of Charge Entry, Payment Posting, Insurance Accounts Receivable (AR), and Patient AR processes to ensure accuracy and compliance with client requirements.
- Processed charge entries and payment postings for hospital and professional claims, including CMS-1500 forms, in accordance with established billing guidelines and standard operating procedures.
- Escalated unresolved billing, coding, and reimbursement issues to clients and management teams for timely resolution.
- Prepared and submitted monthly collection reports, providing detailed analysis of revenue performance, outstanding receivables, and collection trends.
- Maintained compliance with HIPAA regulations, payer guidelines, and revenue cycle management best practices to maximize claim reimbursement and reduce AR aging.
- Collaborated with internal teams to improve process efficiency, enhance quality standards, and achieve client-specific collection targets.
AR Caller cum Analyst - ACCEL HEALTHCARE INDIA PVT. LTD.
(2017-08 - 2018-09)
Specialties: Family Medicine, Behavioral Health
- Managed insurance accounts receivable by reviewing claim status through payer portals and direct communication with insurance companies to ensure timely claim resolution and reimbursement.
- Analyzed and resolved claim denials, rejections, underpayments, and outstanding balances by identifying root causes and implementing appropriate corrective actions.
- Conducted end-to-end quality audits of Charge Entry, Payment Posting, Insurance AR, and Patient AR processes to improve operational accuracy and service quality.
- Processed charge entries and payment postings for hospital and professional claims, including CMS-1500 forms, in accordance with established billing guidelines and standard operating procedures.
- Escalated complex billing and reimbursement issues to clients, facilities, and management teams to facilitate prompt resolution and minimize revenue loss.
- Prepared and submitted monthly collection reports, providing insights into revenue performance, collection trends, and aging receivables.
- Collaborated with cross-functional teams to optimize revenue cycle processes, improve collection efficiency, and reduce claim turnaround time.
- Ensured compliance with HIPAA regulations, payer policies, and industry best practices while maintaining high standards of accuracy and productivity.
Group Leader - TRUEREVMED CONSULTANCY INDIA PVT. LTD.
(2018-10 - 2020-05)
Specialty: Physical Therapy. Application: AdvancedMD
- Led and supervised the Accounts Receivable (AR) team, ensuring timely resolution of claim rejections and denials to maximize reimbursements and meet client turnaround time requirements.
- Reviewed daily rejection and denial reports, identified root causes, and implemented corrective actions to reduce recurring issues and improve collection performance.
- Prepared and presented monthly AR collection reports to management, highlighting outstanding balances, collection trends, and revenue opportunities.
- Served as the primary point of contact for clients, managing communications through calls and emails to address operational, billing, and reimbursement-related inquiries.
- Monitored team productivity, quality metrics, and key performance indicators (KPIs), ensuring adherence to client requirements and organizational goals.
- Provided coaching, guidance, and ongoing support to team members to enhance performance, improve collection outcomes, and maintain service quality standards.
- Conducted regular team meetings to communicate client updates, process changes, and best practices, ensuring alignment across the team.
- Managed Electronic Remittance Advice (ERA) enrollments within the practice management system to streamline payment posting and accelerate receipt of Explanation of Benefits (EOBs).
- Reviewed and corrected misapplied payments and posting discrepancies within the practice management system before client invoicing, ensuring financial accuracy.
- Performed Root Cause Analysis (RCA) on revenue leakage, denial trends, and collection challenges, developing actionable solutions to improve reimbursement rates and reduce AR aging.
- Generated and submitted analytical reports to management for client review, supporting strategic decisions to optimize revenue cycle performance.
- Focused on achieving monthly collection targets while maintaining high-quality standards, operational efficiency, and client satisfaction.
Team Lead - CMPMS Global Private Ltd.
(2020-07 - 2021-07)
Specialty: Physical Therapy. Application: Kareo
- Led and managed the Accounts Receivable (AR) team, ensuring timely resolution of claim rejections and denials to maximize reimbursements and meet client service-level agreements.
- Conducted daily reviews of denied and rejected claims, identified root causes, and implemented corrective actions to improve claim acceptance and reduce AR aging.
- Prepared and presented monthly AR collection reports to management, tracking outstanding receivables, collection performance, and revenue recovery opportunities.
- Acted as the primary liaison between clients and internal teams, handling communications through calls and emails to resolve operational, billing, and reimbursement-related concerns.
- Monitored team productivity, quality metrics, and adherence to client requirements, ensuring achievement of collection targets and operational objectives.
- Provided coaching, mentoring, and performance feedback to team members, fostering a collaborative and high-performing work environment.
- Organized and conducted regular team meetings to communicate client updates, process enhancements, policy changes, and performance expectations.
- Managed Electronic Remittance Advice (ERA) enrollments within the Kareo practice management system to streamline payment processing and expedite receipt of Explanation of Benefits (EOBs).
- Reviewed and corrected payment posting discrepancies and misapplied payments to ensure accurate financial reporting and client invoicing.
- Performed Root Cause Analysis (RCA) on denials, underpayments, and revenue leakage, developing corrective action plans to improve reimbursement outcomes and operational efficiency.
- Generated detailed analytical reports and presented findings to management, supporting strategic initiatives to optimize revenue cycle performance.
- Focused on achieving monthly collection goals while maintaining high-quality standards, regulatory compliance, and client satisfaction.
Collections Team Lead - Zealie Private Ltd.
(2022-01)
Specialty: Behavioral Health. Application: CollaborateMD
- Lead and manage the Collections and Accounts Receivable (AR) team, ensuring timely follow-up and resolution of claim rejections, denials, and outstanding balances to maximize revenue recovery.
- Conduct daily reviews of denied and rejected claims, identify root causes, and implement corrective actions to ensure timely reimbursement from insurance carriers.
- Prepare and present monthly AR collection reports to management, highlighting collection performance, aging trends, and revenue recovery opportunities.
- Serve as the primary point of contact for clients, coordinating through calls and emails to address billing, reimbursement, and operational inquiries while maintaining strong client relationships.
- Monitor team productivity, quality metrics, and key performance indicators (KPIs), ensuring adherence to client expectations and organizational goals.
- Provide leadership, coaching, and performance feedback to team members, fostering professional growth, accountability, and continuous process improvement.
- Conduct regular team meetings to communicate client updates, workflow changes, process enhancements, and performance expectations.
- Manage Electronic Remittance Advice (ERA) enrollments and maintenance within the practice management system to facilitate faster receipt of Explanation of Benefits (EOBs) and streamline payment processing.
- Review and correct payment posting discrepancies, unapplied cash, and misallocated payments to ensure accurate financial records and client invoicing.
- Perform Root Cause Analysis (RCA) on denials, underpayments, and revenue leakage, developing and implementing corrective action plans to improve reimbursement rates and reduce AR aging.
- Generate detailed operational and financial reports for management and clients, providing actionable insights to enhance revenue cycle performance.
- Drive monthly collection initiatives to achieve revenue targets, improve team efficiency, maintain service quality, and enhance client satisfaction.
- Ensure compliance with payer regulations, HIPAA guidelines, and revenue cycle management best practices while supporting continuous operational excellence.
