Karun Sai

• Leads a team of AR professionals responsible for end-to-end accounts receivable follow-up for U.S. healthcare providers.

• Focused on the timely resolution of outstanding claims, reducing aging buckets, and improving overall revenue recovery for clients.

Key Responsibilities:

• Managing a team of AR callers, monitoring performance, and ensuring that daily and weekly targets are achieved.
• Performing AR follow-up on denied, pending, and aged claims to secure timely reimbursement.
• Coordinating with insurance companies, payers, and internal teams for claim status updates, and issue resolution.
• Coaching team members on call quality, process knowledge, and denial management best practices.
• Preparing productivity reports, dashboards, and performance metrics for leadership review.
• Ensuring compliance with HIPAA and organizational quality standards.
Implementing process improvements to reduce denials and enhance overall collection efficiency.

Key Achievements:

• Improved team productivity by 100%.
Reduced AR aging in 60, 90, and 120+ buckets through strategic follow-ups.

Applications used:

• Splashtop – Remote access to client systems and application connectivity.

• GoTo – Payer follow-ups and claim status inquiries.

• Teams Display – EOD Payments Report Sharing, task creation, and client communication.

• Teams Chat – Internal communication, escalations, and real-time clarifications.

• QPS Claims Portal – Claim status review, payer interaction, and follow-up tracking. • Insurance Web Portals.

Training professional with hands-on experience in building capability for branch and field teams across Secured & Unsecured Loans. Specialized in documentation training, credit understanding, risk checks, and compliance. Improved workforce readiness, documentation accuracy, and branch audit performance.

Core Responsibilities:
• Delivered Induction, Process, Product, Compliance & Behavioral training (Classroom + OJT).
• Designed modules on secured/unsecured loan processes, credit parameters & customer handling.
• Trained teams on documentation, verification steps, credit evaluation & policy adherence.
• Conducted TNA/TNI, managed training calendars, assessments, certifications & MIS.
• Supported new product launches, process updates & system enhancements.
• Mentored field trainers and ensured quality & consistency in training delivery.

Key Achievements:
• Reduced documentation errors and improved audit scores across regions.
• Enhanced team capability in loan processing, credit checks & risk assessment.
• Supported large-scale onboarding during business expansion.
• Improved productivity through strong documentation & customer evaluation training.

Loan Process Expertise
• Unsecured Loans: MSME Loan docs, GST/Udyam verification, Trade License checks, FOIR calculation, ABB analysis, eligibility checks.
• Secured Loans: Mortgage docs, property/collateral verification, possession certificates, ownership validation, AUM understanding, risk assessment.

Training Areas Covered:
• KYC, fraud red-flags, PB calls, credit policy, documentation accuracy, customer profiling.

Applications & Tools Used:
• LOS (Loan Origination System)
• Government Portals: MSME, GST, Udyam, Municipality portals for Trade License
• Internal NBFC systems for risk and credit evaluation
• Zoho Mail – Internal & client communication

Delivered end-to-end training on CMS 1500, UB04, dental claims, EOBs, RX/non-standard bills, and instance mapping. Supported onboarding, process training, quality improvement, and cross-training across BSC(Blue Shield of California), and Cigna projects. Managed the full training lifecycle and collaborated with Operations, Quality, and Software teams to improve accuracy and productivity.

Key Responsibilities:

Training Delivery & Development:

• Trained new hires on CMS 1500, UB04, Dental claims, EOB interpretation, keying and instance mapping.
• Conducted onboarding, classroom sessions, OJT, refreshers, and upskilling across LOBs.
• Prepared and updated SOPs, training decks, and assessments.
• Delivered onshore/virtual training and implemented TNI, TNA, TTT, and certification programs.

Process & Quality Improvement:

• Identified OCR issues in FlexiCapture and coordinated fixes with Software/Quality teams.
• Led daily huddles, shared error samples, and improved accuracy using RCA & 5-Why analysis.
• Conducted PKT tests, LMS assessments, and provided SBS coaching to improve productivity.

RMO (Regional Mailing Office) Training:

• Trained teams on prepping, sorting, routing, and identifying keyable vs. unkeyable documents.
• Guided processing of unkeyable items in Facets (Appeals, Correspondence, COB, Triage, Foreign Claims, FEP, HEAT, etc.).

Stakeholder Collaboration:

• Participated in daily error-review calls and calibration sessions.
• Supported floor clarifications and worked with client teams for process updates.

Applications / Tools Used:

• Sympraxis – Image instance data mapping, claims processing, volume allocation, and monitoring
• FlexiCapture – Document processing
• Facets – Case management, task creation, and document routing
• Microsoft Forms – LMS creation, tracking, and assessments
• Microsoft PowerPoint – Training material preparation
• Microsoft Outlook & Microsoft Teams.

Specialized in provider enrollment and credentialing processes within US Healthcare. Experienced in maintaining accurate provider data, validating information, and supporting billing processes.

Key Responsibilities:
• Managed CAQH profiles, including updating attestations, DEA license, and State license information, PLI license updates, and correcting practice location errors.
• Maintained provider demographic and reportable changes to ensure accurate and timely updates.
• Handled data validation requests, reviewing and entering information accurately.
• Knowledgeable in end-to-end provider billing processes, including eligibility verification and claim stages.
• Conducted eligibility verification in Waystar, adding active insurances for inactive patients.
• Managed multiple critical processes simultaneously with efficiency and accuracy.

Key Achievements:
• Ensured accurate provider records, reducing errors in credentialing and billing processes.
• Supported smooth revenue cycle operations through timely updates and data accuracy.

Applications / Tools Used:
• Waystar – Patient insurance eligibility verification
• HP – System navigation and process execution
• Microsoft Outlook – Internal and client communication
• Microsoft Teams – Team collaboration and handling escalations

Worked in medical billing and revenue cycle operations, focusing on charge entry, eligibility verification, and claim adjudication. Experienced in workflow optimization, accurate claim processing, and compliance with US healthcare standards.

Key Responsibilities:

Charge Entry & Eligibility Management:
• Checked patient eligibility online and updated insurance details in the system.
• Updated patient demographic information and insurance details accurately.
• Entered Super Bill charges (CPT & ICD codes) and submitted claims through clearinghouses.
• Managed end-to-end claims processing, ensuring timely and accurate submissions.
• Implemented process improvements, increasing productivity and reducing errors.

Claim Adjudication:
• Applied knowledge of healthcare insurance policies, including in-network/out-of-network rules, deductibles, coinsurance, and copays.
• Processed and adjudicated claims, resolving payment and denial issues while adhering to industry standards.
• Ensured accurate reimbursement and payment processing, meeting or exceeding client SLAs.
• Maintained a strong understanding of claim adjudication, reimbursement methodologies, and revenue cycle operations.

Key Achievements:
• Improved claim submission accuracy and reduced billing errors.
• Strengthened understanding of US healthcare insurance processes and reimbursement workflows.