 Oversight of the activities associated in IT & ITES Projects. Represent Quality Operations on CMC project teams. Handled a team of 179 in Transactional Quality, 744 (366 within Provider Support /378 within Payer Support) in BPO RCM Healthcare Operations & 53 in IT/MIS. Handling RCM Healthcare Medical Billing & F&A International Clients (USA, UK, Australia & Canada) Coordinating with the Human Resource Team in terms of Top Management Recruitment Process. Management of lot disposition activities to ensure that materials are released in accordance with regulatory requirements, cGMPs and policies and procedures and within project lead times. Being a backup in terms of Client Service & Pre-Sales. Joined hands with my IT Team and developed a new internal & a confidential tool called Trapeze which relates to FTE Cost Management and saved $ 1,97,000/- across 7 centre’s within India.  Focused more on Productivity, Quality, TAT, Accuracy, KPI's, SLA's & OLA's. Primary Quality contact for external clients. Joined hands with the Learning & Development Team to develop Technical Competencies for my Operations Team by introducing class room trainings, workshops and portal based online learning with assessments on core subjects like Web Development, Data Science, AI, Python, Cyber Security, Cloud Computing, Mobile App Developments, UI/UX Design, Microsoft Office Tools & Google Analytics. It created a huge impact with people towards developing few technical data analytics which saved Cost, People & Time. Interface with internal departments and external vendors on a variety of technical/quality subjects. Contribute to the evaluation and mitigation of program risks and escalation of potential significant quality issues. Focusing more on Six Sigma, Lean & Kaizen.  Execute day to day activities, planning of deliverables as per availability of agents.  Overseeing and driving all team members and their activities towards every client account.

 Core focuses within to work in medical facilities and assist the revenue cycle department in resolving revenue cycle problems. To supervise and oversee staff in duties pertaining to patient billing, communications with health insurance, collections, cash posting, account management, and contract analysis. Worked and aligned on Capacity Planning by using and implemented tools like Wrike, Parallax, Kantata, Netsuite ERP, Productive, Runn, Saviom, Hub Planner & Resource Guru by reviewing important and confidential client related process documents with the approval of the CEO, COO & CxO’s. Implemented a system to ensure that accurate billing information is entered into the billing system. Handled a team of 269 within RCM Healthcare Operations like Medical Billing, Coding, Transcription, MRR & other CRM Development stuffs. Handled inbound, Outbound, Email, Chat & other data entry services. Supervised the revenue cycle department in various duties, such as account management, communications with insurance providers, collections, cash posting, contract analysis, and billing. Managed staff performance by providing regular feedback, performance reviews, and one-on-one meetings. Handling a team of 112 within Transaction Monitoring as a part of maintaining Process, Project & Account’s quality. Reviewed financial hardship applications. Regular within Process Compliance strategies and conducted audit teams internally within Operations to keep an eye on data privacy, client documents, email monitoring, secure call recordings…etc. Overseen the hiring and training of staff. Efficiently managing patient complaints in respect of billing and collections. Planning and structuring the department workflow and staffing. Correctly coding diagnoses and procedures.

 Managed RCM team operations including all aspects of coding, charge-entry, claims submission, collections and payment posting. Handled a team of 165 within RCM Healthcare Operations – Medical Billing, Coding, Transcription and MRR. Supervises and develops RCM team members. Accountable for regular audits and ground check upon the process analysis within the operational data to foresee issues and to determine areas of priority. Responsibilities include work allocation, training, and problem resolution; evaluating performance and making recommendations for action; motivating employees to achieve peak productivity and performance. Accountable for Process & Continuous Improvement. Managed data analysis by handling effective tools like Tableau, Looker, Knime, Apic RapidMiner, SAS, Power BI, Qlik Sense, Alteryx, SPSS, Google Analytics, Apache Storm, OpenRefine, Data Bricks, Orange, Spot Fire, High Charts & Pentaho. Serves as the resident expert and "go to" person for all coding, billing and collections processes. Develops, reviews and enhances operating policies and procedures to improve quality and efficiency. Analyzes actionable claims data, including revenue and volume, by region, payor, hospital, surgeon, procedure code, etc. Ensures compliance with coding and billing regulations, relevant healthcare regulations and data privacy issues (e.g., HIPAA). Coordinates team member paid time off (PTO) in a manner that does not negatively impact necessary daily functions. Prepares and reviews periodic reports of performance metrics with the VP & SVP – RCM.

 Headed 291 + people in RCM Healthcare - Medical Billing International Project. Taking care of Document Service, Credentials, Pre-Authorization, Claims, Enrollment & Payment Posting. Responsible for day-to-day management with healthcare clients. As a Manager in Revenue Cycle leads overall strategy, optimization and implementation guidance of revenue cycle operations required for the scheduling, registration, insurance verification, financial counseling, charge master, charge capture, HIM/coding, clinical documentation improvement, patient financial services, provision of charity, and overall collection of patient service revenues across the revenue cycle.  Duties and responsibilities include decisions related to investments and changes in net revenue enhancement tactics, software applications, outsourcing vendors, recovery projects, and other interventions to collect the net revenue associated with patient services delivered. An entrepreneurial leader with an eye for opportunity and a thirst for growth.  Communicate with clients and other stakeholders and to solicit input to improve the program; Responsible for all contractual agreements from an operational perspective and ensure realistic and practical commitments are made to clients. Lead all facets of business. Participate in expansion activities. Balance customer satisfaction / demands to maintain customer satisfaction with the level of support the customer has contracted. Excellent delegation skills, negotiation skills and strong people management skills. An entrepreneurial, creative, experienced leader with experience in IT /ITES US healthcare (RCM). Lead the process to a profitable expansion. Serving as a lead to develop, present and execute integrated brand strategy and brand positioning communications programs. Providing proactive high-level client counsel and creative recommendations on how to meet brand marketing goals through communications.

 Managed 122 + staffs performance by providing regular feedback, performance reviews, and one-on-one meetings.  Overseen the day-to-day operations of the RCM Healthcare Department. Tasked with ensuring that my team is performing well and meeting all of the requirements set forth by clients. Overseen the hiring and training of staff.  To monitor, coach, assist, facilitate & conduct regular 1 on 1’s often to evaluate best career prospects / growth methods within the account. Efficiently managing patient complaints in respect of billing and collections. Practiced more within the Process & Continuous Improvements and saved a cost of $80 K towards People & Time. Involved within Kaizen, Six Sigma & Lean to focus more on quality & accuracy.

 Assisted Revenue Cycle Operations Team with all duties and responsibilities and provides any necessary backup to meet specified client needs Handled a team of 64 within Medical Billing, Coding & Transcription Processes Maintains ongoing issues and priority lists for healthcare clients or other tasks as designated to assist Revenue Cycle Operations Manager Analyze daily production reports and assist with providing feedback and resolution on identified issues or trends Assists Revenue Cycle Operations Manager with reporting information critical to Administrative leadership on key performance issues Proactively identifies sources of billing/denial issues and communicates these to the appropriate parties Assists healthcare clients with statistical analysis Makes recommendations to address targeted issues Assist with the allocation of new accounts and assignments to team members Assist with monitoring team performance and provide direction to offshore team regarding claim information and the appropriate solutions to resolve issues Assist Revenue Cycle Operations Manager with the execution, analysis, and optimization of client workflows and in working with off-shore teams Innovation to recognize best employees as a star performers on a weekly, monthly, quarterly and half yearly basis as a part of appreciation. Intention is to recognize and cultivate rising talents. Been a back up within Business Development Transition Team (PATO) which gave me an opportunity to interact with new clients, create documents, manuals, Software’s, Headcount Focus, wrote SLA’s, KPI’s & OLA’s targets, accomplished by transformational plans for both Sales & Marketing with the combined efforts within Operations.  Also reviewed MSA, SOW, SOA, SOP & Project Charter in detail to take commitments, objectives, goals individually for each client within RCM Healthcare to accomplish all targets within TAT.

 Handled a team of 28 + with Medical Billing – core activities involved within Patient Scheduling, Insurance Eligibility & Verification, Charge Entry, Claim Submission Billing, Payment Process, Payment Posting, AR Follow Up & Reporting. Worked on software’s like Advanced MD, DR Chrono, Chart Logic & Kareo. Responsible for supervising billing team in ensuring accurate billing, timely submission of electronic and/or paper claims, monitoring claim status, researching rejections and denials, documenting related account activities, posting adjustments and collections ... Supervising staffs exclusive of Transaction Quality & MIS. Review, monitor and implement improvements to Accounts Receivable processes and systems. Influence changes to systems and processes - open to new ideas coming from team members. Support team members with problem solving and guidance on difficult issues. Leads launch of new client coding projects. Request appropriate access to internal systems for the team. Review posted client guidelines and review general coding… Been concentrated on 1O1’s to provide daily feedback by reviewing each agent Goals, Objectives & Commitments matching per the job roles and responsibilities. Prioritized on 360 Degree feedback to measure certain important tasks. Keenly developed a plan for working corporate company’s culture into the day-to-day work experience by defining values as always.

 Maintain up-to-date expertise and knowledge of healthcare billing laws, rules, regulations and developments necessary for the organization to make informed business decisions and assure compliance with applicable rules & regulations.  Been a back up for Team Leader / acted myself as a SME who takes care of escalations, team meeting, trainings, attrition, shrinkage…etc. Follow through claims. Update supervisors of any trends that are found in respective specialties so that providers can be re-educated. Also to participate in and, where appropriate, lead cross-functional revenue cycle projects are being subjected. Core Functions. Perform all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provide all customers with an excellent service experience by consistently demonstrating core coding knowledge each and every day. Always been the best within Process Transformational Approach by writing and implementing steps like defining transformational goals, Metrics, Benchmarks, Flow Charts, SOP’s, Digitize and Automate, Testing, Scale Up Implementation & defining track changes if any.

 To ensure that all patient information is accurate and complete and request any missing patient information. To obtain and review referrals and authorizations for treatments. To confirm patient benefits and insurance eligibility. To follow and adhere to all regulations and guidelines set by state programs, and HMO/PPO, etc. To transfer insurance claims and billing data to billing software. To update billing software with rate changes. To create both paper and electronic copies of documentation. To develop and maintain a tracking system of incoming and late payments. To follow up on late payments and initiate late payment notices to relevant parties. To work with personal information and maintain patient confidentiality. To monitor and resolve financial discrepancies. To handle and answer all patient or insurance telephone inquiries.