Rahul Bhardwaj

Quality-focused operations professional with 8+ years of experience in audit, compliance, and process improvement within high-volume healthcare operations. Proven expertise in quality assurance, root cause analysis (RCA), error reduction, and KPI reporting. Currently leading teams as a Team Coach, driving audit excellence, SLA adherence, and continuous improvement initiatives. Strong ability to analyse data, identify control gaps, and deliver actionable insights to stakeholders.

Medical Records Specialist (Team Buddy) - Zealie India Pvt. Ltd.

(2024-08)

• Conduct quality reviews and audits on insurance claims to ensure accuracy and compliance.
• Perform end-to-end claim reviews, validating documentation, coding, payer guidelines, and compliance requirements.
• Identify clean claims and proceed with appeal initiation for cases involving retro authorization, medical necessity, and timely filing requirements.
• Perform regular and ad hoc audits across operational tasks including data validation, reconciliations, exception handling, and escalations using defined audit methodologies.
• Design and maintain audit checklists, sampling frameworks, and control mechanisms aligned with operational workflows.
• Review outputs against SLAs, internal procedures, and regulatory requirements; quantify and analyse error rates and categories.
• Analyse error trends and denial patterns, performing root cause analysis to reduce recurring issues.
• Document audit findings with supporting evidence, risk impact assessment, and detailed RCA.
• Prepare and deliver structured audit reports, dashboards, and insights to leadership, stakeholders, and compliance teams.
• Track remediation actions, validate corrective measures, and ensure closure of audit findings.
• Identify process gaps and control weaknesses; recommend practical improvements to reduce errors, rework, and operational risk.
• Develop and implement SOPs, audit frameworks, and process improvements.
• Collaborate with training and quality teams to incorporate audit insights into coaching and learning materials.
• Maintain audit documentation and records in line with internal policies and audit requirements.
• Support internal and external audits through documentation, walkthroughs, and compliance validation.
• Drive continuous improvement initiatives including automation opportunities in audit sampling and reporting.
• Lead team coaching sessions to improve accuracy, productivity, and audit scores.
• Track and report KPIs such as error rates, quality scores, and productivity metrics.

Senior Associate - Clinic Anywhere

(2023-07 - 2024-07)

• Performed detailed analysis of claims, underpayments, and process gaps.
• Managed insurance follow-ups and resolution tracking via calls and portals.
• Created weekly reports and dashboards for stakeholders.
• Identified process inefficiencies and supported continuous improvement initiatives.
• Handled appeals and documentation ensuring compliance and accuracy.
• Supported audit activities by maintaining documentation and validating process adherence.

Associate – Quality Assurance Auditor - CGM ARIA (EMDS)

(2021-04 - 2022-07)

• Conducted end-to-end quality audits on AR workflows ensuring compliance with payer and internal standards.
• Identified process gaps, control weaknesses, and error trends through RCA.
• Delivered audit reports, feedback, and performance insights to stakeholders.
• Monitored and reported quality KPIs (accuracy %, error rates, rework).
• Developed audit frameworks, SOPs, and quality guidelines.
• Maintained audit documentation and supported internal/external audit requirements.
• Supported training and coaching programs to improve team performance.
• Collaborated with cross-functional teams for process improvement initiatives.

Senior Associate - Nthrive Global Solutions Pvt. Ltd.

(2017-08 - 2021-04)

• Managed AR lifecycle including denial analysis and resolution tracking.
• Identified recurring issues and implemented process improvements.
• Created performance reports and operational dashboards.
• Worked closely with stakeholders to ensure timely resolution and compliance.

Associate - Porteck India Info Services Pvt. Ltd.

(2015-07 - 2017-07)

• Handled insurance claims processing and follow-ups.
• Identified denial patterns and supported team training initiatives.
• Maintained productivity and performance reports using Excel.

Bachelor of Commerce - B.Com - University of Delhi

Senior Secondary

Higher Secondary