Vishal Waghela

Results-oriented and highly experienced leader and specialist in Medical Billing and Claims, with over 7 years of expertise in healthcare revenue cycle management. Adept at leading teams, overseeing claim adjudication, ensuring compliance, and driving process improvements in medical billing and coding, as well as claim denial management. Proficient in managing both Medicare and commercial insurance claims, improving claim resolution times, and reducing aging accounts.

Seeking to leverage my experience in medical billing, team leadership, and client relations to take on a Supervisor role within a dynamic healthcare organization.

Subject Matter

Expert and trusted advisor skilled in research, analysis and examination of company technology and standard operating procedures. Interface and collaborate with clients and internal team members, providing consultative enhancement recommendations based on industry research. Improve existing processes, procedures, technical enhancements, resource requirements, and stakeholder engagement procedures to align with strategic goals.

Insightful

Leader dedicated to providing strategic and technical leadership to technical teams. Skilled in troubleshooting and resolving complex information technology problems by performing technical root cause analysis and providing viable solutions.

Subject Matter Expert - Credence Resource Management - Pune

(2022-06)

• Supervise 50+ associates across AR, Billing, Prior Authorization, and Patient Inbound Calling departments.
• Lead efforts to clear all department queues within 48 hours of their create date in adherence to strict client SLAs.
• Resolve aging accounts by identifying interdepartmental delays and streamlining handoffs between teams.
• Collaborate with clients daily via Microsoft Teams, email, and calls to resolve account-level concerns, present reports, and align operational strategies.
• Prepare and deliver daily and weekly reports, including: Charge Reconciliation (charges received, worked, and pending), Bank Reconciliation (received vs. posted payments), Queue Tracking across AR, Coding, Billing, Authorization
• Achieved a 40% reduction in denial backlog within 3 months through process re-engineering.
• Implemented training programs that improved claim accuracy and reduced denials by 15%.

Senior AR Facility Management - Gebbs Healthcare Solutions - Mumbai

(2021-10 - 2022-06)

• Led a team of medical billing specialists handling complex claims and client escalations in the hospital billing domain (ESRD).
• Oversaw BCBS inventory management and worked to resolve high-value denied claims by coordinating with insurance providers and healthcare facilities.
• Trained new hires and junior team members on claims software (Nextgen, ECF) and industry best practices for claim adjudication.
• Identified trends in claim rejections and implemented corrective measures to improve team performance and meet key performance indicators (KPIs).
• Ensured compliance with regulatory standards (HIPAA) and internal quality benchmarks.
• Reduced claim denial rate by 20% through targeted denial management initiatives.
• Improved team performance and productivity by 30% through hands-on mentoring and process adjustments.

Senior AR Associate - Pacific BPO - Noida

(2020-12 - 2021-09)

• Managed accounts receivable for high-value clients, focusing on complex claim follow-ups and resolving outstanding claims (365+ days).
• Responsible for handling client escalations and providing detailed reports on outstanding accounts and claim statuses.
• Worked closely with internal teams to resolve errors in claim coding, eligibility verification, and documentation.
• Utilized Epic and proprietary billing software to process claims and ensure accurate reimbursements.
• Resolved over $200K in denied claims within 3 months by systematically addressing common rejection causes.
• Contributed to a 15% improvement in team KPIs through targeted training and workflow optimization.

Senior Account Receivable Specialist - Gebbs Healthcare Solutions - Mumbai

(2018-11 - 2020-09)

• Handled a diverse portfolio of medical claims, specializing in eligibility & benefit verification, radiology claims, and medical/behavioral health claims.
• Worked directly with insurance providers (Medicare, Medicaid, BCBS) to resolve complex denials and rejections.
• Led the implementation of process improvements, resulting in a reduction of claim rejections and aging accounts.
• Reduced average claim resolution time by 25% through improved workflows and real-time issue tracking.
• Ensured SLA compliance and improved team performance through data-backed coaching and mentoring.
• Managed daily operations of the AR team, ensuring compliance with SLAs, client specifications, and internal guidelines.
• Successfully reduced aged accounts by 30% within six months through diligent follow-up and issue resolution.
• Led cross-functional initiatives that improved claim submission accuracy and processing time.

Higher Secondary Certificate - Maharashtra Board (2015-01)

Secondary School Certificate - Maharashtra Board (2013-01)