Next Gen
David Samuel
Quality Analyst AR
Bangalore
Summary
Results-driven QA Analyst with Optimize RCM Pvt Ltd, specializing in AR quality analysis and denial management. Expert in root cause analysis and CAPA implementation, enhancing accuracy and compliance. Proven ability to coach agents, leading to improved performance and reduced rework. Proficient in MS Excel for insightful reporting and trend analysis.
Overview
2
2
years of professional experience
5
5
Languages
Work History
QA Analyst
Optimize RCM Pvt Ltd
08.2024 - Current
- Performed in-depth quality audits on AR workflows including insurance follow-ups, denial resolution, payment posting, and appeals to ensure accuracy and compliance.
- Conducted root cause analysis (RCA) on audit defects and implemented corrective and preventive actions (CAPA) to minimize repeat errors.
- Analyzed denial trends (CO-45, CO-50, CO-97, CO-16, CO-29) and validated corrective actions prior to claim resubmission.
- Reviewed EOBs/ERAs to ensure correct posting of payments, adjustments, and contractual balances.
- Ensured strict adherence to SOPs, client guidelines, payer policies, and HIPAA compliance standards.
- Prepared and maintained QA scorecards, audit summaries, and trend reports using advanced MS Excel (Pivot Tables, VLOOKUP/XLOOKUP, IF formulas, dashboards).
- Delivered actionable feedback and coaching to AR agents, resulting in improved accuracy and reduced rework.
- Participated in calibration sessions with team leads and clients to align quality standards and scoring methodology.
- Monitored aging AR buckets and highlighted high-risk accounts to prevent revenue leakage and SLA misses.
- Supported internal and external audits by maintaining detailed documentation and audit trails.
Senior AR Analyst
Tharworxs Pvt Ltd
08.2023 - 07.2024
- Managed end-to-end AR activities including insurance follow-ups, denial resolution, payment posting review, and appeals across multiple payers.
- Performed in-depth analysis of aging AR (0–30 / 31–60 / 61–90 / 90+) and prioritized high-value and high-risk accounts to maximize collections.
- Resolved complex claim denials (CO-45, CO-50, CO-97, CO-16, CO-29) by identifying root causes and coordinating corrections with billing and coding teams.
- Reviewed EOBs / ERAs to ensure accurate posting, contractual adjustments, and identification of underpayments.
- Prepared and submitted appeals with supporting medical records and payer-specific documentation.
- Maintained strict adherence to payer guidelines, client SOPs, timely filing rules, and HIPAA compliance.
- Utilized payer portals and insurance calling to obtain claim status, resolve discrepancies, and escalate unresolved issues.
- Created AR performance and aging reports using MS Excel (Pivot Tables, VLOOKUP/XLOOKUP, Filters) to track collections and trends.
- Supported team leads and QA teams by clarifying denial patterns and process gaps to reduce rework.
- Met or exceeded productivity, quality, and SLA targets consistently.
Education
Bachelor of Commerce -
Rabindranath Tagore University
Madhya Pradesh01.2025
Skills
Accounts Receivable (AR) Quality Analysis
Revenue Cycle Management (RCM)
Denial Management & Trend Analysis
Root Cause Analysis (RCA) & CAPA
EOB / ERA Review & Payment Accuracy
SOP, Client & HIPAA Compliance
Medicare, Medicaid & Commercial Payers
QA Reporting & Scorecard Preparation
MS Excel
Agent Feedback, Coaching & Communication
Software
Athena IDX
ECW
Jaguar
Timeline
QA Analyst
Optimize RCM Pvt Ltd
08.2024 - Current
Senior AR Analyst
Tharworxs Pvt Ltd
08.2023 - 07.2024
Bachelor of Commerce -
Rabindranath Tagore University