Technophile
Hrithik Yadav
Medical Claims Specialist
Greater Noida
Summary
Experienced Healthcare RCM and Medical Billing Specialist with expertise in end-to-end billing, medical collections, and denial management. Skilled in ICD-10, CPT, and DRG coding to ensure accurate reimbursements and compliance. Knowledgeable in Athena, Epic, and Cerner EMR/EHR systems, leveraging AI-assisted operations to streamline workflows and enhance efficiency. Collaborates effectively with providers and payers to resolve discrepancies while maintaining HIPAA compliance.
Overview
1
1
Certification
7
7
years of professional experience
Work History
Medical Claims Specialist
Gabeo.ai
Remote
05.2025 - Current
- Trained AI systems on healthcare claim denials, appeals logic, payer guidelines, and reimbursement workflows to improve healthcare automation accuracy.
- Reviewed denied claims and identified recurring denial trends to support workflow optimization and reduce manual rework.
- Created structured healthcare datasets for AI validation and claims analysis initiatives.
- Collaborated with technical and operational teams to validate AI-generated healthcare outputs and improve claims processing accuracy.
- Utilized Athena and insurance payer portals for healthcare documentation verification, claim review, and workflow support.
- Supported healthcare workflow automation projects by analyzing payer responses, claim statuses, and denial patterns.
Senior Executive
CorroHealth
Noida
09.2023 - 05.2025
- Managed insurance follow-up, appeals handling, and denial management processes for unpaid and underpaid medical claims.
- Reviewed remittance advice and reimbursement details to ensure billing accuracy and compliance with payer guidelines.
- Resolved denied claims through detailed claim analysis, documentation review, and communication with insurance companies.
- Collaborated with coding and billing teams to address claim discrepancies and improve reimbursement turnaround time.
- Maintained accurate healthcare documentation and claim activity records to support audit readiness and compliance standards.
- Provided refresher training to new team members on denial resolution workflows and insurance follow-up processes.
Senior Analyst
R1 RCM
Noida
03.2023 - 09.2023
- Reviewed unpaid and denied claims while performing appeals and escalation management activities.
- Prepared productivity and claims status reports to support operational decision-making and workflow tracking.
- Coordinated with healthcare teams and insurance representatives to resolve billing discrepancies efficiently.
- Ensured compliance with healthcare operational procedures, quality benchmarks, and documentation standards.
AR Analyst
Pacific BPO Pvt. Ltd
Noida
12.2021 - 03.2023
- Handled AR follow-up activities, denial analysis, and insurance communication for outstanding medical claims.
- Identified root causes of denials and implemented corrective actions to improve payment recovery workflows.
- Performed claim corrections and follow-up activities to minimize write-offs and improve reimbursement rates.
- Trained new team members on denial handling procedures, appeals processing, and insurance follow-up protocols.
Assistant Accountant
Time Zone
06.2019 - 03.2020
- Managed accounts payable and receivable processes while supporting reconciliation and financial documentation activities.
- Maintained accurate accounting records and assisted in improving internal financial tracking processes.
Education
Bachelor of Commerce (B.Com) -
Kalinga University
Chhattisgarh07.2021
Skills
EMR/EHR Systems: Epic, Cerner, Athena
Medical Coding: CPT, ICD-10, ICD-9, and DRG Classification
Billing & Collections: End-to-end medical billing, patient/insurance collections, and audit readiness
Claims Management: Claims resolution (95% rate), denial analysis, insurance follow-up, and appeals
AI & Workflow Optimization: Training AI on appeals logic, dataset structuring, and Google Gemini
Quality Compliance: HIPAA compliance, patient-focused care, and root cause error analysis
Tools: MS Office (Excel/Access), OneSource, and Insurance Portals
Languages: English (C1 Advanced)
Certification
Data Analyst Program (Pursuing) — Simplilearn / IBM
Interests
Fitness Enthusiast
Reading
Timeline
Medical Claims Specialist
Gabeo.ai
05.2025 - Current
Senior Executive
CorroHealth
09.2023 - 05.2025
Senior Analyst
R1 RCM
03.2023 - 09.2023
AR Analyst
Pacific BPO Pvt. Ltd
12.2021 - 03.2023
Assistant Accountant
Time Zone
06.2019 - 03.2020
Bachelor of Commerce (B.Com) -
Kalinga University