Sandeep Rai

With over 5+ years of experience in Revenue Cycle Management (RCM), I specialize in delivering high-impact analysis and process optimization across diverse healthcare settings. I have a proven track record in handling complex data workflows manually and through leading-edge tools like Epic (Resolute HB), Athena, Cerner, and Clearinghouses such as ZirMed/Waystar. I bring hands-on expertise in managing the full spectrum of RCM functions, including Patient Demographics Management, Insurance Verification & Eligibility check, EDI Rejections Resolution, Patient Chart & Documentation, Hospital Billing & UB04 Claim Form, Medicare and Medicare Rebilling Process, and Compliance with HIPAA and Industry Standards.

My strong familiarity with Practice Management Systems (PMS) and Electronic Health Records (EHR/EMR) has enabled me to streamline operational processes, reduce claim denials, and improve overall revenue cycle performance.

Senior Associate - WNS HOLDINGS

(2024-07 - 2024-08)

Dental Billing Specialist

• Prepared and submitted dental insurance claims for payment, using correct procedure codes (CDT).
• Informed patients about their co-payments, deductibles, and any services not covered by their insurance.
• Contacted dental insurance companies to check patient benefits and coverage details.
• Found out why claims were denied or rejected and corrected the issues to resubmit them.
• Updated patient information, including personal details and insurance data, in the system.
• Kept all patient information private and followed HIPAA rules at all times.
• Worked with the dental team to make sure billing was accurate and patients were informed about costs.

Senior Analyst - R1 RCM

(2019-05 - 2024-04)

Experienced and detail-oriented Senior Analyst with a strong background in Revenue Cycle Management (RCM), specializing in manual data analysis and operational efficiency across multiple EHR/EMR platforms including Epic Resolute, Athena, Cerner, and clearinghouses such as ZirMed/Waystar. Demonstrated expertise in Practice Management Systems, medical billing, Medicare/patient claims data, and payer/provider services. Proficient in analysing and improving workflows related to demographics, rejections/denials, patient charts, and health benefit verification, while ensuring strict adherence to HIPAA compliance and industry regulations.

Adept at working across the entire revenue cycle to optimize processes, reduce claim denials, and enhance patient and provider experiences. Committed to data accuracy, healthcare compliance, and maintaining high standards of patient data integrity to support effective decision-making and improve healthcare outcomes.

Business Process Associate - Believers Management Consultant (Fiserv India)

(2018-06 - 2019-03)

• Conducted detailed Fraud analysis to detect and prevent suspicious or unauthorized activities within the B2C platform.
• Monitored transaction patterns and customer behaviour to identify fraud risks in real time.
• Collected and analyzed customer data to understand usage trends, detect anomalies, and improve fraud detection accuracy.
• Used customer location data to enhance product visibility, ensuring the right products are shown to the right customers based on geography.
• Worked with product and business teams to develop location-based strategies that improve product discovery and user engagement.
• Helped reduce financial and reputational risks by flagging suspicious activity and working with internal teams for quick resolution.
• Improved customer trust and platform security by maintaining consistent fraud monitoring and prevention processes.
• Contributed to building a better user experience by combining data insights with product optimization for targeted customer segments.

B. Tech - Bio-Technology - SHARDA UNIVERSITY, Greater Noida (2017)