Abhishek Kumar Tripathi
Assistant Program Manager
Gurgaon
Summary
Results-driven healthcare professional with 10+ years in Revenue Cycle Management (RCM). Expertise in denial prevention strategies to enhance claim acceptance and minimize revenue leakage. Skilled in process improvement initiatives that streamline operations and reduce manual workload. Proficient in software testing, ensuring the integrity and quality of healthcare systems throughout the software testing life cycle.
Overview
1
1
Language
1
1
Certification
13
13
years of professional experience
Work History
Assistant Program Manager
R1 RCM
10.2023 - Current
- Assistant Program Manager : Promoted within organization in November 2025
- Specialist – Denials Prevention Management ( Oct-2023-Nov-2025)
- Managed end-to-end revenue cycle operations, optimizing claim processing to enhance reimbursement accuracy.
- Analyzed initial denials to accelerate cash flow by identifying trends related to authorization and credentialing issues.
- Developed cross walk reports which help to resolve denial by cross validating the data in different system
- Preparing decks and ad-hoc and regular reports to monitor progress and identify gaps.
Process Lead
Capgemini
10.2022 - 10.2023
- Reviewed requirements and understood business and technical needs to effectively plan testing activities.
- Created detailed test cases, test data, and test scenarios based on functional requirements to ensure comprehensive coverage.
- Executed manual testing of applications (functional, regression, integration, UI testing) to identify and document defects.
- Review Requirements, understand business and technical requirements to plan testing activities.
- Led process optimization initiatives, enhancing operational efficiency across multiple projects.
Senior claim Associate
Optum Global Solution
03.2019 - 09.2022
- Managed electronic remittance posting to ensure accurate payment applications and manual processing of denials.
- Reviewed overpayments to identify discrepancies
- Led claims processing initiatives, enhancing operational efficiency through streamlined workflows.
- Analyzed complex claims to ensure compliance with regulatory standards and company policies.
- Mentored junior associates, fostering skill development and knowledge sharing within the team.
Senior Account Receivable Associate
R1 RCM
04.2016 - 03.2019
- Prioritized high aging and high dollar amount claims to enhance collections
- Improved follow-up approach by creating a list of insurers with self-registered portals, reducing the need for calls.
- Streamlined operational workflows to enhance efficiency within revenue cycle management processes.
- Led cross-functional teams to implement process improvements, driving increased accuracy in claims submissions.
- Mentored junior associates on best practices and compliance standards, fostering a culture of continuous learning.
Associate
Accretive Health
08.2015 - 02.2016
- Managed denial claims by coordinating with insurance representatives to resolve issues.
Associate
IGATE Global Solution
07.2013 - 07.2015
- Responsibility- Claim adjudication
Education
High School - Science
KV Vikaspuri
Delhi, India 04.2001 -
Intermediate - Science
KV New Cantt
Prayagraj, India06-2006
Bachelor of Engineering - Electronic Engineering
RGTU
Bhopal, India 04.2001 -
Skills
- MS Excel, SQL, Snowflake, Power BI, MS PowerPoint
- MS Excel
- SQL
- Snowflake
- Power BI
- MS PowerPoint
Certification
Microsoft Power BI
CORE COMPETENCIES
- Process improvement and workflow Automation
- End-to-End Revenue Cycle Optimization
- Denial Management & Prevention Strategy
- SQL, Snowflake, Advance Excel, EDI configuration, STLC
- KPI Monitoring & Metric Enhancement
- Root Cause Analysis & Corrective Action Planning
NOTABLE HIGHLIGHTS
- Identified over ~$10M in annual revenue improvement opportunities through the eligibility cross walk
- Led Missing contractual opportunity, focused on highlighting accounts where there we missed the contractual adjustment.
- Led Provider agreement testing, focused on validating the system that claim processed as per agreement and fee Schedule in system or not.
PERSONAL DETAILS
Address: Vikaspuri, India 110018
Timeline
Microsoft Power BI
07-2025
Assistant Program Manager
R1 RCM
10.2023 - Current
Process Lead
Capgemini
10.2022 - 10.2023
Senior claim Associate
Optum Global Solution
03.2019 - 09.2022
Senior Account Receivable Associate
R1 RCM
04.2016 - 03.2019
Associate
Accretive Health
08.2015 - 02.2016
Associate
IGATE Global Solution
07.2013 - 07.2015
High School - Science
KV Vikaspuri
04.2001 -
Bachelor of Engineering - Electronic Engineering
RGTU
04.2001 -
Intermediate - Science
KV New Cantt