Nagesh Mulka

Results-driven Revenue Cycle Management (RCM) professional with 14+ years of experience in U.S.

Healthcare Medical

Billing and Revenue Cycle Operations. Expertise in end-to-end medical billing processes, including Demographics Verification, Eligibility Verification, Charge Entry, Payment Posting, Accounts Receivable (AR) Management, Denial Management, and Claims Resolution. Proven experience leading teams, improving operational efficiency, ensuring compliance with healthcare billing standards, and maintaining strong client relationships.

Skilled in analyzing revenue cycle performance, managing billing workflows, and driving collections through effective AR follow-up.

Team Lead – Revenue Cycle Management - PhyCARE Solutions - Hyderabad

(2011-10)

Manage end-to-end Revenue Cycle Management operations for U.S. physician practices.

• Oversee daily billing activities including demographic verification, eligibility verification, coding validation, charge entry, claim submission, payment posting, and AR follow-up.
• Ensure timely transmission of electronic and paper claims to maximize reimbursements and collections.
• Monitor and resolve clearinghouse rejections and claim denials.
• Perform ERA, insurance, patient, and manual payment postings accurately.
• Analyze and work on open AR accounts to improve collection rates.
• Review aging reports and implement corrective actions for outstanding claims.
• Mentor and support team members to achieve operational goals and quality standards.
• Prepare weekly and monthly operational reports for management and clients.
• Review AR aging reports and prioritize claims based on claim age.
• Investigate denials and initiate appropriate corrective actions.
• Follow up on 'No Activity Claims' that exceed 30 days without payer response.
• Conduct volume analysis covering patient visits, charges, and payments.
• Monitor collection trends and identify revenue leakage opportunities.
• Generate and validate patient statements.
• Review payer policy updates and implement process changes.
• Analyze and resolve credit balance accounts.
• Process refunds for overpayments made by insurance companies or patients.
• Prepare monthly practice performance summaries and AR reports.
• Participate in client review meetings and process improvement discussions.

Master of Computer Applications - MCA - Kakatiya University (2010)