AMOL GAIKWAD

Neighbor Health / Ok Valley Hospital (Hospital Billing)

• Working in the U.S. medical billing sector with expertise in AR follow-up, denial management, and hospital billing.
• Handling registration denials, claim errors, and claim rejections for timely resolution.
• Managing client escalation files, ensuring quick turnaround, and accurate claim corrections.
• Performing payment posting, denial posting, and redaction with high accuracy.
• Identifying denied and unpaid claims, analyzing root-cause issues, and re-filing corrected claims to reduce rejections.
• Skilled in minimizing AR days, preventing aged AR, and improving claim acceptance rates.
• Strong ability to analyze rejection reasons, correct claims, and re-submit clean claims without failure.
• Self-motivated, with a strong sense of personal responsibility.
• Excellent communication skills, both verbal and written.
• Proven ability to learn quickly and adapt to new situations.
• Skilled at working independently and collaboratively in a team environment.

Client Project

Project Title: Claim Submission Error Reduction and Workflow Correction.

Project Overview: The client was unable to submit claims electronically due to repeated clearinghouse-level errors, which led to claim delays and increased AR days. I was assigned to identify the root causes, correct the data, and implement a clean submission workflow.

Key Responsibilities:

• Analyzed claim submission failures and clearinghouse rejection reports.
• Identified critical errors, including: invalid patient name and member ID, missing or incorrect replacement ICN, entity not found errors, patient demographic mismatches, incorrect guarantor relationship, and missing/invalid subscriber details.
• Updated patient demographics, subscriber information, and guarantor relations in the EHR.
• Corrected billing data to meet payer and clearinghouse requirements.
• Re-filed corrected claims electronically, with zero submission failures.
• Coordinated with clearinghouse support to ensure claim integrity.

Project Outcome:

• Successfully eliminated clearinghouse submission errors.
• Improved clean claim rate, and reduced AR days.
• Enabled faster and smoother reimbursement cycles.

• Contacting insurance companies to verify authorization status and obtain required approvals.
• Reviewing patient eligibility and coverage to confirm active benefits and coverage requirements.
• Handling provider credentialing and enrollment processes to ensure timely onboarding.
• Participating in client meetings, and managing client escalations to resolve issues effectively.

• Working in the U.S. medical billing sector as a Revenue Cycle Representative (Senior Specialist, Accounts Receivable).
• Working as a special AR for workers' compensation and motor vehicle claims.
• Professional Billing (Mass General Brigham)
• Working on client escalation files, claim rejections, payment posting, denial management, denial posting, and redaction.
• Identifying denied or unpaid claims, re-filing the corrected claims, minimizing AR days, and eliminating aged AR.
• Highly skilled in analyzing the reasons for claim rejection, correcting the claims, and re-filing without delay. Also, it is essential to examine denial patterns and find proper solutions to eradicate future occurrences of denials.
• Following up with the claim adjuster, attorney, and insurance carrier.
• Working in no response work queue, negotiated claims rejection, e-mail writing, daily target 50.
• Provider: Mass General Brigham.
• Payor: All payors.
• Every month, the quality score is 100%, and the production score per month is 135% or higher.

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• Resolving complaints and issues efficiently and in a timely manner.
• Meeting sales/revenue targets.
• Ensuring client satisfaction

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