Santosh Rawat
Medical Billing and Revenue Cycle Management (RCM) Specialist
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About
Results-driven Medical Billing and Revenue Cycle Management (RCM) Specialist with 9+ years of experience in denial management, accounts receivable (AR) follow-up, EDI rejection handling, and end-to-end billing processes. Proven expertise in improving claim acceptance rates, reducing denials, and optimizing revenue cycle performance. Experienced in team leadership, process training, and client communication within hospital and physician billing environments.
Experience
Denial Analyst / RCM Specialist - Steward Global Consulting (St. Mary Medical Centre)
(2023-11)
- Analyse insurance denials and identify trends to improve first-pass resolution rate
- Perform root cause analysis and prepare RCM performance reports
- Review and approve write-offs and manage credit balance accounts as per payer guidelines
- Handle EDI rejections and ensure timely correction and resubmission of claims
- Support credentialing reporting for provider onboarding and compliance tracking
- Assist coding team with claim-related queries and documentation gaps
- Develop training materials and conduct software/process training for new hires
Senior AR Analyst / SME / Assistant Team Lead / Trainer / Team Lead - Inficare Services Pvt. Ltd.
(2018-02 - 2023-11)
- Managed end-to-end RCM operations including charge entry, payment posting, AR follow-up, and denial resolution
- Led a team of AR analysts and ensured achievement of KPIs (collections, aging, productivity)
- Designed and delivered training programs, including SOPs, presentations, and assessments
- Conducted internal audits to ensure billing accuracy and compliance with payer guidelines
- Managed process transitions and implemented workflow improvements
- Led Train-the-Trainer initiatives to standardize onboarding and improve team performance
Senior Medical Billing Specialist - Porteck India Info Services Pvt. Ltd/Rsystem
(2016-11 - 2018-01)
- Processed medical claims, payment posting, and follow-ups on unpaid or denied claims
- Maintained compliance with payer rules and billing regulations
- Collaborated with AR and denial teams to improve turnaround time
AR Analyst - Pacific BPO Pvt. Ltd.
(2015-01 - 2016-10)
- Performed insurance follow-ups on denied, underpaid, and aged claims
- Assisted in reporting and tracking collections and AR performance
Education
Bachelor of Arts - HNB Garhwal University (2012)
Intermediate (CBSE) - Army Public School, Roorkee (2009)
High School (CBSE) - Army Public School, Roorkee (2007)
