Chandan Matoliya
Hyderabad
Summary
Quality Specialist with 9+ years in US Healthcare RCM across Quality Audits, AR Follow-up, and Team Mentoring. MBA in Finance & Marketing. Consistently delivered 99% quality and 120%+ productivity while exceeding client SLAs. Expert in RCA, calibration, SOP creation, and process improvement across Athena, NextGen, Waystar, and Cerner platforms. Results-driven professional with a strong foundation in quality assurance and process optimisation. Demonstrates exceptional analytical skills and a commitment to continuous improvement, fostering collaboration across teams to drive performance and meet organisational objectives. Utilises advanced software skills to manage data and enhance reporting accuracy.
Overview
1
1
Certification
10
10
years of professional experience
Work History
Quality Specialist
R1 RCM
01.2023 - Current
- Conduct RCM audits for AR, Eligibility & Benefits, and Appeals processes
- Lead weekly calibrations with operations team and provide floor assistance to improve team quality
- Prepare individual quality reports and lead weekly quality team meetings for process improvements
- Identify operational issues and devise action plans; prepare utilisation reports for management on agent performance
- Communicated daily audit status to Business Intelligence Team for monthly business reviews
- Joined R1 RCM as senior associate, focusing on operational efficiency; promoted to QA after clearing IJP
- Developed and maintained risk registries, JDs, SOPs, process documents, user matrices, and organisational charts
AR - Follow Up Associate
R1RCM Global Private limited
07.2020 - 05.2023
- Handled rejections, correspondence, and denial management for US healthcare accounts receivable, ensuring timely resolution of outstanding issues
- Prepared weekly update trackers and action plans for Out-of-TAT cases
- Streamlined processes by collaborating with two teams and addressing clarification encounters, enhancing operational consistency
- Ensured month-end activities completed on time with accuracy; handled day-to-day process operations
- Coordinated ramp-up batch training and provided daily status updates to manager while monitoring turnaround time and backlogs
Senior Associate
Inventurus Knowledge Solution
Hyderabad
01.2017 - 01.2020
- Promoted from Trainee to Senior Associate for exceeding client SLAs; maintained 99% quality, 120%+ production, 98% attendance
- Conducted internal team audits to ensure SLA quality adherence and mentored team on achieving targets
- Monitored SOP updates and identified process gaps, proposing corrective actions for underperforming agents
- Delivered feedback on agent soft skills and process knowledge, guiding freshers on process queries
Education
M.B.A - Finance & Marketing
TKR Educational Society
01-2015
B.Com - Computers
Kakatiya University
Adilabad01-2013
Skills
- RCM Platforms: NextGen
- RCM Platforms: Athena
- RCM Platforms: Waystar
- RCM Platforms: Payer Path
- RCM Platforms: Availity
- RCM Platforms: Cerner Practice Management
- RCM Platforms: HP Billing Software
- RCM Functions: AR Follow-up
- RCM Functions: Denial Management
- RCM Functions: Eligibility & Benefits
- RCM Functions: Prior Authorization
- RCM Functions: Medical Billing
- Quality: Audit
- Quality: Root Cause Analysis
- Quality: Calibration
- Quality: SOP/JD Creation
- Quality: Utilization Reporting
- Quality: Process Improvement
- Software: Advanced Excel (Macros, Pivot Tables, VLOOKUP)
- Software: MS Office Suite
Languages
English
Hindi
Telugu
Marwari
Custom
- Travel
- Stocks Market
- Cooking
Personal Information
Father's Name: Radheshyam Matoliya
Certification
- Lean Six Sigma project completion : Yellow Belt
1) NVA Touch elimination & workflow optimization
2) Credentialing workflow optimization
Timeline
Quality Specialist
R1 RCM
01.2023 - Current
AR - Follow Up Associate
R1RCM Global Private limited
07.2020 - 05.2023
Senior Associate
Inventurus Knowledge Solution
01.2017 - 01.2020
M.B.A - Finance & Marketing
TKR Educational Society
B.Com - Computers
Kakatiya University