Kavya Sharma

Quality Control and Quality Assurance

• Conducted comprehensive quality audits daily to ensure adherence to company and client standards.
• Identified process gaps and implemented quality control measures to enhance accuracy and efficiency.

Audit of AR Processes (Accounts Receivable)

• Performed regular audits of AR workflows to ensure billing accuracy, compliance with policies, and timely resolution of discrepancies.
• Ensured documentation integrity and adherence to HIPAA, and client-specific guidelines.

Performance Monitoring.

• Tracked and evaluated agent performance through daily and weekly quality reports and dashboards.

Feedback, Training, and Mentoring

• Delivered structured feedback to team members based on audit findings, promoting consistent quality improvement.
• Designed and facilitated training sessions on quality standards, AR processes, and client-specific requirements.
• Acted as a mentor for new hires and underperforming members, helping them align with organizational goals and KPIs.

Claims and Denial Management – Hospital Billing

• Investigated, addressed, and resolved denials by analyzing EOBs/ERAs and payer correspondences, ensuring timely and accurate resubmission, and retrieving payment from insurance companies.
• Collaborated with internal departments to rectify billing errors and prevent recurring denials, improving overall cash flow.

Appeals Creation and Submission.

• Drafted and submitted appeals for denied or underpaid claims, aligning with payer-specific guidelines, and medical necessity documentation.
• Maintained detailed records of appeal statuses and outcomes, contributing to improved appeal turnaround times and win rates.
• Worked with the coding team to gather the necessary documentation to support successful appeal resolutions.

Trend Analysis.

• Conducted an in-depth analysis of denial and payment trends.

Mentoring

• Provided guidance and support to junior AR analysts, enhancing team performance and knowledge sharing.

AR Follow-up

• Conducted proactive follow-up with insurance companies to resolve outstanding claims, reduce aging accounts, and ensure timely reimbursements. Also, worked on rejections.

Claims and Denial Management – Physician Billing

• Analyzed remittance advices (EOBs/ERAs) to identify denial reasons, coordinated with coding teams for corrections, and ensured timely resubmissions.

Worked with multiple specialty providers.

• Handled claims processing and AR follow-up for providers across various specialties, including cardiology, orthopedics, etc.

Appeal Creation and Submission.

• Drafted detailed, payer-compliant appeals for denied or partially paid claims, including medical necessity justifications, and supporting documentation.