Arvind Kumar
Vaishali
Summary
Dedicated professional seeking to leverage years of experience in RCM medical billing processes and leadership skills to contribute effectively in a dynamic healthcare organization. Motivational Team Leader skilled in designing and following production schedules. Offers proven history of maximizing team productivity to meet targets. Dedicated to employee safety and proactive assignment, schedule, and personnel management.
Overview
14
14
years of professional experience
Work History
Team Leader - RCM Medical Billing
Jindal Health Care
Noida
11.2023 - Current
- Insurance Verification: Proficient in verifying patient insurance coverage, benefits, and eligibility using various platforms and databases
- Skilled in navigating different insurance plans, including PPOs, HMOs, Medicare, and Medicaid, to facilitate accurate billing and minimize claim denials
- Charges and payments – Tracking all the Charges and Payment records, Reconciling and client SLA and Quality parameters
- Authorization Management: Proven track record in obtaining pre-authorizations for medical procedures, treatments, and diagnostic tests
- Experienced in collaborating with healthcare providers, insurance companies, and patients to streamline authorization processes and ensure compliance with payer requirements
- Team Leadership: Strong leadership abilities demonstrated through effective supervision of teams engaged in insurance verification and authorization
- Skilled in training staff on best practices, maintaining productivity, and fostering a culture of accountability and excellence
- Process Improvement: Adept at identifying inefficiencies and implementing process improvements to enhance workflow efficiency and reduce turnaround times for insurance verification and authorization
- Implemented strategies that have led to reduced authorization processing time
- Compliance and Quality Assurance: Ensure adherence to HIPAA regulations and insurance policies to protect patient confidentiality and data integrity
- Conduct audits and quality checks to maintain accuracy and consistency in insurance verification and authorization processes
- Communication and Collaboration: Excellent interpersonal skills with a proven ability to communicate effectively with patients, healthcare providers, insurance representatives, and internal stakeholders
- Foster positive relationships to facilitate smooth operations and resolve issues promptly
- In my previous roles, I have successfully managed complex insurance verification and authorization tasks, contributing to enhanced patient satisfaction and improved revenue cycle management for healthcare organizations
- I am passionate about leveraging my skills and experience to drive operational excellence and support the strategic goals of your organization
- I look forward to discussing how my background, skills, and achievements align with the needs of your team during the interview process
Team Coach
CGM Aria (Formerly known as Emds)
Noida
09.2019 - 11.2023
- Managed full-cycle medical billing processes for a portfolio of healthcare providers, including claim submission, payment posting, and accounts receivable follow-up
- Resolved complex billing issues and denials promptly, ensuring timely reimbursement and accurate financial reporting
- Conducted regular audits to maintain compliance with HIPAA regulations and coding guidelines, resulting in a reduction in billing errors
- Collaborated with providers and insurance companies to resolve outstanding claims and expedite payment processing
Denial Specialist
Rsystem International
Noida
01.2019 - 09.2019
- Developed strategies to resolve complex issues related to denials.
- Monitored assigned accounts for payment resolution or appeal opportunities.
- Advised providers on coding changes required for accurate reimbursement.
- Maintained accurate records of all denied claims, appeals, and outcomes for reporting and analysis.
- Collaborated with healthcare providers and insurance companies to gather additional information and resubmit denied claims.
- Analyzed claim denials data to report on patterns and performance metrics to management.
- Monitored trends in claim denials to identify opportunities for process improvement and training.
- Conducted detailed research on complex denial cases to determine the root cause and appropriate appeal strategy.
Workers' Compensation Claims Representative
Nthrive Global Solutions Pvt Ltd
Noida
09.2017 - 05.2018
- Advised management on best practices related to workers' compensation claims handling procedures.
- Analyzed data related to workers' compensation claims including injury severity, causation and duration of benefits.
- Communicated with various departments within an organization regarding claim updates.
- Investigated claims to determine eligibility and reviewed medical reports, documents and other evidence.
- Input claim information and payments into company database.
Denial Specialist
Accretive Health Services Pvt Ltd
Noida
08.2015 - 01.2017
- Responded promptly to customer inquiries about claim status or denied services.
- Participated in internal audits of departmental processes that impact revenue cycle operations.
- Investigated and documented payment errors resulting from incorrect processing of claims.
- Resolved billing disputes between providers and third party payers in a timely manner.
- Analyzed and interpreted policy language, medical records, and other relevant data to identify coverage issues.
- Identified any discrepancies in patient information, provider information, or coding accuracy as part of the denial process.
- Compiled data from multiple sources into meaningful summary reports for management review.
- Provided training on proper coding techniques for staff members who submit claims electronically.
- Analyzed claim denials data to report on patterns and performance metrics to management.
- Maintained accurate records of all denied claims, appeals, and outcomes for reporting and analysis.
- Monitored trends in claim denials to identify opportunities for process improvement and training.
- Ensured compliance with healthcare regulations and insurance policies during the denial management process.
- Conducted detailed research on complex denial cases to determine the root cause and appropriate appeal strategy.
Insurance Specialist
EXL services Pvt Ltd
Noida
09.2013 - 07.2015
- Evaluated customer applications and determined eligibility for coverage based on established criteria.
- Provided guidance to customers regarding available insurance plans and their benefits and limitations.
- Maintained accurate records of all transactions related to insurance policies.
- Coordinated with other departments within the organization regarding issues related to policy administration.
- Responded promptly to customer inquiries about their policies and provided timely updates as needed.
- Facilitated dispute resolution between customers and insurance providers when necessary.
- Fostered relationships with customers to expand customer base and retain business.
Payment Poster
Portack India Info Services Pvt Ltd
Noida
01.2011 - 01.2013
- Posted payments for insurance companies, including Medicare and Medicaid, by accurately entering data into the system.
- Maintained accurate records of all payments posted in an organized filing system.
- Collaborated with various departments within the organization to ensure efficient workflow processes related to payment posting activities.
- Processed incoming payments from patients and insurance companies in a timely manner.
- Assisted in resolving payment issues, such as rejections or delayed payments due to incorrect coding or missing information.
- Ensured adherence to HIPAA guidelines when handling confidential information.
- Researched discrepancies between patient accounts and remittance advice received from insurance carriers.
- Balanced daily cash postings with deposits to ensure accuracy of information entered into the system.
- Followed up on pending claims that have not been paid by third-party insurers within specified timeframes.
- Verified accuracy of statements sent to customers for payment reconciliation purposes.
- Participated in departmental meetings concerning improvements in existing payment processes.
- Reviewed denials received from payers and communicated findings with billing staff.
Education
Bachelor of Arts (B.A.) -
C.C.S. University, Meerut, U.P
01.2011
Skills
- Insurance Verification
- Verifying patient insurance coverage
- Verifying patient insurance benefits
- Verifying patient insurance eligibility
- Navigating insurance plans
- PPOs
- HMOs
- Medicare
- Medicaid
- Billing
- Claim denials
- Charges and payments tracking
- Reconciling payment records
- Client SLA
- Quality parameters
- Authorization Management
- Obtaining pre-authorizations
- Collaborating with healthcare providers
- Collaborating with insurance companies
- Collaborating with patients
- Streamlining authorization processes
- Compliance with payer requirements
- Team Leadership
- Supervision
- Training staff
- Maintaining productivity
- Fostering a culture of accountability
- Process Improvement
- Identifying inefficiencies
- Implementing process improvements
- Enhancing workflow efficiency
- Reducing turnaround times
- Compliance and Quality Assurance
- HIPAA regulations
- Insurance policies
- Patient confidentiality
- Data integrity
- Conducting audits
- Quality checks
- Communication and Collaboration
- Interpersonal skills
- Effective communication
- Positive relationships
- Issue resolution
Timeline
Team Leader - RCM Medical Billing
Jindal Health Care
11.2023 - Current
Team Coach
CGM Aria (Formerly known as Emds)
09.2019 - 11.2023
Denial Specialist
Rsystem International
01.2019 - 09.2019
Workers' Compensation Claims Representative
Nthrive Global Solutions Pvt Ltd
09.2017 - 05.2018
Denial Specialist
Accretive Health Services Pvt Ltd
08.2015 - 01.2017
Insurance Specialist
EXL services Pvt Ltd
09.2013 - 07.2015
Payment Poster
Portack India Info Services Pvt Ltd
01.2011 - 01.2013
Bachelor of Arts (B.A.) -
C.C.S. University, Meerut, U.P
Similar Profiles
GURSHARAN JOSSANGURSHARAN JOSSAN
Staff Nurse at Jindal Health ServicesStaff Nurse at Jindal Health Services
Michael HenryMichael Henry
Plasma Operator at Jindal Tubular USAPlasma Operator at Jindal Tubular USA
RAVI DIVAKARRAVI DIVAKAR
Associate Manager-PPC at Jindal Stainless LimitedAssociate Manager-PPC at Jindal Stainless Limited