Yamini G

Dedicated US-based Medical Billing and RCM professional with 6 years 7 months of expertise in healthcare operations, recently transitioned into AI-driven healthcare product development, contributing to ML models for denial prediction, claim automation, and intelligent healthcare agents. Strong expertise in RCA, CAPA, AR management, clean claim optimization, and healthcare analytics, with proven ability to bridge business and technology teams.

Senior Quality Assurance (RCM) | AR Lead Responsibilities & AI SME Exposure - Primrose Health - Coimbatore

(2025-03)

• Managed claim quality audits, denial analysis, and RCA to improve claim accuracy and reduce rejections.
• Worked on process improvements to enhance CCR, CDR, and overall billing efficiency.
• Prepared training datasets, validated outputs, and provided functional feedback to improve model accuracy.
• Acted as a bridge between RCM operations and technical teams.
• Leading AR team activities including workload allocation, escalation handling, and performance tracking.
• Monitoring AR ageing, denial trends, and focusing on high-value claims for faster resolution.
• Supporting team members through quality checks, feedback, and process guidance.
• Collaborating with leadership on priority issues and revenue-impacting decisions.

Quality Analyst – Provider Reimbursement - Logix Healthcare - Coimbatore

(2022-06 - 2024-12)

• Managed UHC API audit process for 12 months, achieving 98% accuracy by identifying and eliminating recurring errors.
• Reviewed production processes and identified quality defects, implementing CAPA measures that significantly reduced recurring issues.
• Trained and mentored new team members on denial categories, AR calling techniques, and claims processing tools.
• Analyzed and resolved claim denials, processed adjustments, and delivered trend-based reports to leadership.
• Handled inquiries and follow-ups with insurance carriers to resolve unpaid claims aged 365+ days.
• Collaborated on client calls to tackle bulk claim rejections, ensuring service-level targets were consistently met.

Executive RCM – AR Caller - Logix Healthcare - Coimbatore

(2019-06 - 2022-06)

• Managed aging AR buckets, ensuring timely resolution of outstanding claims.
• Handled provider reimbursements and monitored denied claims for appeals.
• Submitted daily claims and resolved rejections to maintain clean claim rates.
• Monitored and followed up on aging claims to ensure timely collections.
• Conducted outbound calls to insurers to expedite payments and resolve denials.
• Filed appeals for underpaid claims and provided reporting on resolution success rates.

B. Com - Professional Accounting - Kovai Kalaimagal College of Arts and Science (2016 - 2019)