MALAR KALIYAN
Chennai
Summary
Dedicated U.S. Healthcare Revenue Cycle Specialist with extensive expertise in end-to-end medical billing, denial management, and accounts receivable follow-up. Former Quality Analyst for Provider Billing at Modernizing Medicine, recognized for enhancing operational efficiency and process improvements. Proficient in data analytics tools including Power BI, SQL, and Python, with a focus on transitioning to healthcare analytics. Strong communicator and analytical thinker with a proven track record in leading teams to reduce errors and improve customer satisfaction.
Overview
11
11
years of professional experience
Work History
Quality Control Analyst
Omega Healthcare Management Services
01.2020 - 12.2024
- Conducted quality audits on medical billing processes, claims, and documentation to ensure accuracy and compliance
- Reviewed and analyzed medical records, claims, pre-billing, coding, and billing data to identify errors and discrepancies
- Developed and maintained quality control procedures, guidelines, and checklists to ensure consistent and accurate billing practices
- Collaborated with teams to provide feedback, training, and guidance on improving accuracy and compliance
- Monitored key quality metrics and prepared reports for management, highlighting areas for improvement
- Stayed updated on medical billing regulations, coding guidelines, and industry best practices
- Assisted in resolving complex billing issues, denials, and appeals
- Supported RCM operations across multiple specialties: Podiatry, Ophthalmology, Dermatology, OBGYN, USFAS, ENT, and Orthopedics
- Reduced denial rates by 20% through workflow optimizations and payer-specific billing strategies
- Developed data-driven reports using Power BI & Excel, analyzing AR trends, payment delays, and claim rejections
- Trained teams on ICD-10, CPT, HCPCS coding basics, appeals handling, and best practices in RCM workflows
- Worked with Practice Management (PM) EMR/EHR software to streamline claim processing and revenue cycle operations
Senior AR & Denial Follow-Up Specialist / Senior Accounts Receivable Executive
01.2019 - 01.2020
- Worked on outstanding claims to ensure timely payment
- Contacted insurance companies via phone, email, and payer portals
- Investigated unpaid claims, resolved rejections, and submitted appeals when necessary
- Updated billing systems with claim statuses and follow-up actions
- Analyzed denial reasons (COB issues, coding errors, medical necessity, timely filing)
- Worked with internal teams to correct and resubmit denied claims
- Prepared and submitted appeals with supporting documentation
- Identified denial trends and suggested process improvements
Senior AR Caller
Global Healthcare
03.2018 - 11.2018
- Specialized in payer-specific billing guidelines, improving claim accuracy and reducing rejection rates
- Resolved outstanding claims aged over 90+ days, expediting reimbursements
Senior AR Caller
HCL Technologies | Apria Healthcare
03.2016 - 03.2018
- Managed rental period claims for oxygen cylinders
- Ensured compliance with payer policies for accurate invoicing and reimbursement
- Addressed claim denials related to equipment maintenance and replacement
Customer Support Executive
TBSS | Beachbody
02.2014 - 02.2015
- Provided email and chat support for fitness products and subscription services
- Assisted customers with account management, billing issues, order processing, troubleshooting, order modification, order cancellation, and placing new orders
- Maintained customer satisfaction (CSAT) excellence
- Utilized CRM tools and ticketing systems for efficient customer interactions
Education
Bachelor of Engineering (B.E.) - ECE
Bharathiyar Institute of Engineering for Women
Salem, Tamil Nadu04.2012
Some College (No Degree) - Data Science
Guvi
ChennaiSkills
- Revenue Cycle Management (RCM)
- Workflow optimization
- Medical Billing
- Denial Management
- AR Follow-Up
- Process Improvement
- Quality Analysis
- Insurance Denials
- Claims Resolution
- Data Analytics
- Excel
- SQL
- Power BI
- Python
- Pandas
- Web Scraping
- Medical Billing Specialties
- Podiatry
- Dermatology
- Orthopedics
- Ophthalmology
- ENT
- Pain Management
- OBGYN
- Software Expertise
- EClinicalWorks (eCW)
- Aristo
- ACIS
- Citrix
- Payer Portal Navigation
- Claims Adjudication
- Stakeholder Communication
- Client Communication
- Quality Auditing
- Process Compliance
- Trend Analysis
- Reporting Dashboards
- Pivot Tables
- VLOOKUP
- Conditional Formatting
- Dashboard Creation in Excel
- Customer Support
- CRM Tools
- Billing Software
- Compliance
- HIPAA
- CPT
- HCPCS
- ICD-10
- Order Modification
- Order Cancellation
- Placing New Orders
- Billing accuracy
- Reporting skills
- Team collaboration
- Process improvement
- Customer service
- Problem solving
- Data analysis
- Quality auditing
- Attention to detail
- Effective communication
- Training delivery
- Investigation support
- Time management
- Documentation review
- Corrective actions
- Customer focus
- Sampling procedures
- Sampling protocols
- Quality improvement
- Sampling
- SOP development
- Performance assessment
- Requirements gathering
- Requirements analysis
- Development team collaboration
- Cost-reduction methods
- Correction action planning
- QC investigations
- Data validation
- Training material development
- Support case resolution
- Audit processes
- Protocol review
- Continuous improvement
Additional Information
Open to new opportunities in US Healthcare RCM, leveraging a strong background in healthcare., Strong expertise in workflow efficiency & RCM optimization., Proficient in Citrix, CRM, CSAT, EMR, HIPAA, Power BI, Microsoft Excel, NetSuite, Python, SQL, VLOOKUP, Pivot Tables.
Timeline
Quality Control Analyst
Omega Healthcare Management Services
01.2020 - 12.2024
Senior AR & Denial Follow-Up Specialist / Senior Accounts Receivable Executive
01.2019 - 01.2020
Senior AR Caller
Global Healthcare
03.2018 - 11.2018
Senior AR Caller
HCL Technologies | Apria Healthcare
03.2016 - 03.2018
Customer Support Executive
TBSS | Beachbody
02.2014 - 02.2015
Bachelor of Engineering (B.E.) - ECE
Bharathiyar Institute of Engineering for Women
Some College (No Degree) - Data Science
Guvi
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