Shiva Shanu

Senior Accounts Receivable Specialist and Denials Management Expert with extensive expertise in navigating complex revenue cycles and claim adjudication processes for international healthcare providers across the US and UK markets. Highly skilled in auditing, analyzing, and resolving sophisticated insurance denials, with deep technical knowledge of demographic verification, primary and secondary coordination of benefits (COB), and intricate patient liability breakdown structures. Adept at meticulously calculating distinct financial responsibilities for both insurance carriers and individual patients, ensuring total transparency across copays, coinsurance, deductibles, and non-covered charges.

A proactive and strategic communicator, proven in successfully negotiating directly with US and UK insurance agents, conducting secure multi-channel patient outreach for compliance verification, and acting as a dedicated patient advocate to mediate multi-tier insurance disputes. Demonstrated ability to overcome operational bottlenecks, maximize reimbursement velocity, and significantly reduce outstanding aged accounts receivable while maintaining peak service quality and customer satisfaction.

Account Receivable (Senior Process Consultant) - Sagility - Hyderabad

• Effectively communicated with international clients, customers, and insurance representatives across the US and UK healthcare sectors.
• Recognized as a top-performing employee and received appreciation for outstanding contributions and commitment to operational excellence.
• Delivered impactful presentations and knowledge-sharing sessions to support team development and process improvement initiatives.
• Consistently achieved and exceeded productivity targets while maintaining high levels of accuracy and quality.
• Specialized in handling and resolving denials related to Demographic Errors (Demo), Other Insurance, Name/Number Mismatches, and Co-pay issues.
• Assessed client requirements and implemented effective solutions to enhance claim resolution and customer satisfaction.
• Demonstrated strong resource management and problem-solving abilities to maximize team and operational performance.
• Proven ability to work independently as well as collaboratively within cross-functional teams.
• Possess excellent verbal and written communication skills with a strong customer-focused approach.
• Skilled at analyzing situations from multiple perspectives to identify efficient and effective solutions.
• Adaptable and resilient in overcoming challenges, maintaining productivity and quality under pressure.
• Trained and mentored new team members on processes, quality standards, and best practices to ensure successful onboarding and performance.
• Consistently maintained over 95% quality and productivity scores, exceeding organizational performance standards.
• Managed medical billing and payment reconciliation processes, ensuring accurate calculation of insurance claim amounts and patient responsibilities

B.Sc. - MScs - St. Joseph's degree and PG college (2017)

MPC - Narayana junior college (2012)

SSC - St. Mark's high school (2010)