Ravendra Jha

Results-oriented and highly effective Team Leader with extensive experience driving operational excellence within US Healthcare Revenue Cycle Management (RCM). Proven ability to lead and develop high-performing teams focused on Denial Management, Accounts Receivable (AR) follow-up, and process optimization through strategic automation initiatives. Expertise in enhancing productivity, improving quality metrics, reducing denial backlogs, and ensuring stringent compliance with HIPAA and client-specific requirements.

Adept at stakeholder management, capacity building, and fostering collaborative, accountable team environments.

Team Leader (US Healthcare) at Commure India PVT (2023-12 – 2026-07)

Led and managed a team of RCM specialists, overseeing all aspects of Denial Management processes to ensure efficient claim resolution.

• Monitored daily productivity, quality metrics, and Service Level Agreement (SLA) adherence, consistently exceeding client expectations.
• Coached and mentored team members through regular feedback, one-on-one sessions, and targeted performance improvement plans, fostering professional growth.
• Analyzed operational data to identify key trends, systemic bottlenecks, and opportunities for significant process improvements, driving efficiency gains.
• Ensured strict adherence to HIPAA regulations, client-specific Standard Operating Procedures (SOPs), and internal quality standards.
• Resolved complex production issues and client escalations with promptness and effectiveness, minimizing operational disruption and maintaining client satisfaction.
• Developed and implemented impactful automation rules that demonstrably reduced claim denials and enhanced overall processing efficiency.
• Collaborated cross-functionally with Quality Assurance, Training, Workforce Management, and Operations teams to elevate team performance and operational synergy.
• Prepared and presented comprehensive daily, weekly, and monthly performance reports to senior management and key stakeholders, providing actionable insights.
• Cultivated a positive, collaborative, and highly accountable team culture, promoting teamwork and high performance.

Business Analyst (Healthcare) at Future Focus Infotech Pvt.Ltd (CLIENT-TCS) (2023-03 – 2023-07)

Contributed to the National Health domain as a Business Analyst for the PMJAY 1.0 Project (National Health Authority - NHA).

• Managed the Transaction Management System (TMS) for all Change Requests (CR) and Service Requests (SR), ensuring efficient workflow.
• Proposed strategic solutions for implementing Change Requests across various NHA schemes including CGHS, CAPF, CONVERGENCE, HEM, GREEN CHANNEL, and E-RUPI.
• Led requirement gathering sessions, developed Business Requirements Documents (BRD) and Functional Requirements Documents (FRD), and facilitated Joint Application Development (JAD) sessions with clients and stakeholders.
• Coordinated effectively with stakeholders and project managers to capture detailed functional and non-functional requirements.
• Performed high-level analysis of requirements to assess the feasibility of new application development from a business perspective.
• Maintained strong, collaborative working relationships with teammates and management to achieve expected Quality Assurance (QA) results for the project team.
• Conducted regular project-related presentations to management and end-users throughout the Software Development Life Cycle (SDLC).

Team Lead in US Healthcare at RRJ INFO TECH (2022-01 – 2023-03)

Led a team of analysts and a Subject Matter Expert (SME) coach in AR follow-up, guiding efforts to reduce aging AR and optimize collections.

• Managed daily team activities and operations, ensuring efficient workflow and resource allocation.
• Served as the primary point of contact for clients regarding process-related queries and managed first-level escalations, ensuring timely and satisfactory resolutions.
• Performed quality checks on AR follow-ups and EOB denial analyses before submission to management/clients, ensuring accuracy and compliance.
• Monitored and managed daily workflows and targets to ensure timely delivery and consistent adherence to agreed-upon SLAs.
• Maintained up-to-date Standard Operating Procedures (SOPs) and established robust control mechanisms to ensure process integrity.
• Participated in new pilot projects and facilitated smooth transitions, identifying portfolio trends to enhance collections and improve productivity.
• Collaborated with managers to effectively resolve personnel issues and conflicts within the team, fostering a harmonious work environment.
• Demonstrated proficiency in RCM, AR, and denial management, contributing to improved financial outcomes.
• Possessed strong knowledge and experience in the end-to-end RCM cycle, from claim submission to payment posting.
• Utilized strong American English communication skills with a neutral accent, effectively interacting with internal and external clients, including proficiency in presentations.

SR. ACCOUNT RECEIVABLES ANALYST (SCCE)(US Healthcare) at NLBSERVICES (CLIENT- NTT) (2019-03 – 2022-01)

Applied expertise in RCM, AR, and denial management to resolve complex client situations and optimize revenue recovery.

• Ensured accurate and timely completion of AR transactions, consistently meeting or exceeding client SLAs.
• Acted on behalf of insurance companies, handling inbound calls from providers to address claim status, eligibility, and outstanding AR.
• Managed the preparation and submission of Appeals, Medical Records, and W9 forms to payers, ensuring all documentation was complete and accurate.
• Successfully resolved EDI rejections, minimizing revenue leakage.
• Maintained functional knowledge of HIPAA rules and regulations, ensuring compliance in all AR activities.

Sr.AR ANALYST (AR) at R1RCM (2018-09 – 2019-03)

Conducted follow-up calls to US insurance companies on behalf of physicians to verify claim status, eligibility, and resolve outstanding Accounts Receivable.

• Executed timely and appropriate follow-up actions on outstanding AR based on denial reasons, driving claim resolution.
• Identified and resolved medical claims billing and reimbursement issues, focusing on maximizing collections and minimizing AR aging.
• Performed denial trend analysis, interpreted payer reimbursement guidelines, and resolved bulk issues or escalated complex cases to management for review.
• Successfully managed and resolved EDI rejections, ensuring smooth claim processing.
• Maintained functional knowledge of HIPAA rules and regulations, ensuring compliance in all AR follow-up activities.

ACCOUNT RECEIVABLES ANALYST at CLOVER BLOBAL SERVICES PVT.LTD (2016-05 – 2018-09)

Managed denial and aged claims for all payers, contributing to improved AR performance.

• Conducted Medicare and Medicaid follow-up, ensuring timely claim submission and payment.
• Processed and resolved Electronic Data Interchange (EDI) rejection claims, minimizing revenue delays.
• Prepared and submitted reconsiderations and appeals for denied claims, maximizing recovery rates.
• Handled No-Fault/WC claims submission and follow-up, ensuring compliance and efficient processing.
• Responded to patient calls as per client instructions, providing excellent customer service.
• Shared daily quality reports and claim count reports for the entire team, promoting transparency and accountability.
• Maintained daily, weekly, and monthly quality reports for the team, enabling performance tracking and improvement.
• Proficiently utilized RCM tools including Medics, Availity, Navinet, and TriZetto.

B.A in Psychology, Economics – Bundelkhand University - Jhansi (2007)