Mahankali Bhargav Shekhar

-Streamlined RCM workflows to cut AR days and increase clean claim rates using data-driven insights

-Designed and implemented RCM KPI dashboards to enhance executive visibility into AR performance

-Led RCM analytics workshops to up-skill staff on data tools, metrics interpretation, and practical applications

-Collaborated with billing and coding teams to analyze denial trends and apply data-driven solutions that reduced denials

-Aligned analytics initiatives with financial goals through collaboration with stakeholders and RCM directors, boosting cash collections.

• Collaborating with onshore partners in streamlining the process and reviewing the inventory on weekly basis
• Preparing SOPs on various complex scenarios which can help the team members for better processing on invoices towards resolution
• Publishing reports on daily inventory w.r.t Dollar vs Aging for all work queues
• Performing quality audits on daily basis and publishing data on weekly basis and providing the feedback to the users on quality errors
• Publishing the inventory reports w.r.t to denials and reason code for top 5 payers across the work queues
• Taking daily team huddles to discuss on issues, process scenarios and challenges that team is facing, to provide resolutions and keeping team engaged
• Preparing weekly Decks for client call which include teams production, quality and daily inventory flow
• Simplifying the inventory by finding various trends and also mitigate the repeated steps in consolidating team production and preparing daily & weekly reports

• Preparing SOPs on various complex scenarios which can help the team members to understand and take necessary actions
• Maintaining the process updates tracker on regular basis, based on the updates provided by onshore
• Conducting monthly PKT’s with the team to ensure all the team members are well versed on the subject knowledge
• Tracking daily inventory flow from all the work Queues on aging, high dollar, and top contributing refunds
• Finding Global issue/ trends from all the work queues to reduce the bulk inventory
• Helping the team on the requirements in the absence of supervisor
• Effectively involved in the team huddles on daily basis to understand any process challenges and documenting the minutes for better understanding
• Prime responsibility is to audit worked inventory and share the daily audits scores, monthly quality scores with the team
• Provide feedback session to the entire team based on the error trend analysis identified on audits
• Resolving issues identified in the process and providing appropriate results to external and internal teams
• Maintain escalation tracker based on the client feedback received and implementing learning opportunities with the team
• Providing resolutions on client responses and emails
• Very much focused on achieving business metrics internal and external
• Engaging the team on employee engagement activities in absence of supervisor

• Working on healthcare claims and resolving the aged inventory in the given time frame
• Worked on denials to ensure there is one touch resolution on the invoices processed
• Co-ordinating with other departments to understand the resolution and taking appropriate action
• Worked on high dollar inventory besides that also focused to maintain 100% quality
• Assisting new joiners in the team and resolving any process related quires
• Taken additional initiatives in consolidating and tracking inventory report on process level
• Responsible in consolidating the daily production files worked by the team members
• Basis on my performance I have been promoted to Subject Matter expert G-24 at Optum Global advantage

• Worked on various denials and sending paper appeal letters to insurance in resolving the denials
• Preparing Denial Dash boards and publishing into client portal
• Working on Ratio Analysis and revenue gain/loss reports for the project
• Conducting quality checks on claims billing process
• Preparing Quality reports based on the speciality wise and presenting to the physicians
• Sending the new providers list to insurances for provider credentialing data
• Co-ordinating with payment posting team in identifying the credit invoices and resolving the credit

• Review and Audit healthcare claims from Quality and Compliance perspective
• Prepare weekly review reports and release Leadership and Compliance Dashboards weekly, monthly, and Quality dashboards
• Provide floor support to executives on process knowledge by conducting daily meeting and monitor quality of the projects by doing RCA on the errors
• Provide timely feedback to the process associates
• Manage Reiteration of Process flows among peers
• Prepare exit/movement report across the projects and ensure 100% adherence to the checklist
• Maintain client complaints tracker and voice of customer’s tracker
• Key responsibility to conduct risk analysis, monitor quality control and reduce process gaps to mitigate any compliance violation and implementation of protective measure
• Trained new hires on Compliance aspects aspect and track and conduct Annual Compliance
• Publish the monthly score card for client metrics for all the sub processes and track the action plans for all the not met metrics