Manoj Suresh Pardeshi

Key Responsibilities:

Team Management & Leadership:

• Lead and supervise a team of 25 to 50 professionals, including 4 Subject Matter Experts (SMEs) and 2 Team Leaders.
• Conduct regular team huddles, performance reviews, and skill development initiatives to ensure team effectiveness.

RCM Operations:

• Manage the Accounts Receivable (AR) and No Surprises Act (NSA) functions for emergency, outpatient, and inpatient services.
• Monitor daily inventory of hospital billing claims that are underpaid or denied, focusing on Out-of-Network (OON) claims.

NSA Compliance & Resolution:

• File Open Negotiations with payers in compliance with the CMS No Surprises Act (2022) guidelines.
• Track payer responses, maintain records, and ensure timely follow-up to drive favorable outcomes.
• Escalate unresolved negotiations by filing IDR (Independent Dispute Resolution) through the CMS portal.

Reporting & Communication:

• Prepare and present comprehensive performance reports and dashboards to senior leadership.
• Highlight key trends, success metrics, and opportunities for process improvements with positive business impact.

Process Optimization:

• Identify opportunities for process automation and efficiency enhancement to reduce manual efforts and turnaround times.
• Collaborate with cross-functional teams to implement technology-driven solutions in the RCM workflow.

Job Summary:

Experienced and dedicated Assistant Manager with a strong background in U.S. healthcare RCM, responsible for end-to-end revenue cycle functions from eligibility verification to patient collections. Successfully led a large team of 85 members, ensuring accuracy, compliance, and timely execution of all processes to maximize revenue and operational efficiency.

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Key Responsibilities:

Team Management & Leadership:

Managed and mentored a high-performing team of 85 staff members across multiple RCM functions.

Supervised daily operations across departments, including Eligibility Verification, Charge Entry, Billing, Payment Posting, AR, Denial Management, Appeals, and Patient Follow-up.

Conducted performance reviews, provided coaching, and implemented process improvements to boost team productivity and accuracy.

Revenue Cycle Operations:

Oversaw the Eligibility & Benefit Verification process to ensure patients' insurance coverage and policy details were validated before services.

Monitored and controlled Charge Entry operations for accuracy in CPT/ICD coding and charge capture to avoid rejections or delays.

Ensured accurate and timely Medical Billing in compliance with payer-specific guidelines and HIPAA regulations.

Supervised Payment Posting (ERA & manual), ensuring correct allocation of payments, adjustments, and write-offs.

Managed Accounts Receivable (AR) follow-up, targeting aging buckets to improve collections and reduce outstanding AR days.

Handled Denial Management, identifying root causes, implementing corrective actions, and reducing denial rates.

Led the Appeals and Reconsideration process for denied or underpaid claims to ensure proper reimbursement.

Oversaw Patient Collections and Follow-up, managing inbound and outbound communication for balance resolution and financial counseling.

Compliance & Quality Assurance:

Ensured compliance with HIPAA, payer policies, CMS regulations, and internal quality benchmarks.

Regularly audited processes and claims to identify discrepancies, trends, and training needs.

Implemented standardized SOPs and control measures to minimize errors and improve first-pass claim acceptance rates.

Process Improvement & Reporting:

Analyzed performance metrics, productivity dashboards, and KPI reports to track progress and set future goals.

Collaborated with cross-functional departments to automate repetitive tasks and streamline workflow.

Prepared and presented weekly/monthly operational reports to senior leadership with insights and recommendations.

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Key Skills & Competencies:

In-depth knowledge of the entire U.S. RCM cycle

Strong leadership and people management abilities

Familiarity with payer policies, CPT/ICD coding, and billing software

Proficient in data analysis, reporting tools (Excel, Power BI), and process automation

Effective communication, problem-solving, and decision-making skills

Strong knowledge of HIPAA, CMS, and payer compliance regulations.

Key Responsibilities:

COVID-19 HRSA Claims Handling:

• Processed and submitted high volumes of COVID-19 related claims under the HRSA Uninsured Program for testing, treatment, and vaccination.
• Ensured accurate documentation, coding, and submission based on evolving CDC and CMS guidelines during the public health emergency.
• Tracked claim statuses and performed timely follow-up with HRSA to resolve pending, rejected, or denied claims.
• Managed appeals for denied claims due to eligibility, coding, or policy issues.

Accounts Receivable (AR) & Denial Management:

• Handled end-to-end AR follow-up across multiple payers to ensure faster reimbursements and minimized aging.
• Investigated and resolved claim denials, identifying trends and implementing corrective actions.
• Coordinated with billing, coding, and provider teams to gather supporting documents and resubmit corrected claims.
• Maintained documentation and reporting for claim statuses, denials, appeals, and resolution timelines.

Genetic Disorder RCM Handling:

• Managed full-cycle RCM for genetic disorder and specialized lab services, including eligibility verification, charge entry, billing, and collections.
• Ensured medical necessity, pre-authorization, and proper documentation to support claim submission for genetic testing services.
• Worked closely with providers and labs to collect accurate patient and clinical data required for successful reimbursement.

Contingency-Based Revenue Collection:

• Operated in a contingency model, where payment was based on successful collections — maximizing both revenue recovery and claim quality.
• Prioritised high-value and time-sensitive claims to enhance provider cash flow during the pandemic.
• Delivered performance above benchmarks in claim resolution rate, reimbursement turnaround, and denial overturn rate.

• HRSA Uninsured Program and COVID-19 claim processing
• Genetic and molecular lab billing
• Denial analysis and appeals handling
• AR follow-up and payer communication
• US healthcare RCM compliance and documentation
• Contingency-based collections strategy
• Strong understanding of CPT/ICD coding and medical necessity
• Effective verbal and written communication with payers and clients.

Key Responsibilities:

Accounts Receivable (AR) Follow-up:

• Conducted thorough follow-up with U.S. insurance payers on aging AR to ensure timely and accurate reimbursement for acute care claims.
• Prioritised high-dollar and high-risk accounts to accelerate cash recovery and reduce AR days.
• Maintained daily work queues, monitored claim status, and documented actions within billing platforms.

Denial Management:

• Investigated claim denials and rejections, identified root causes, and implemented corrective and preventive actions (CAPA).
• Collaborated with coding and billing teams to resubmit corrected claims and supported appeals with appropriate documentation.
• Reduced denial rates by proactively addressing payer-specific patterns and coding errors.

Escalation Handling & Revenue Improvement:

• Led a focused initiative to reduce escalation-prone accounts, minimizing client complaints and improving issue resolution time.
• Implemented best practices to address long-standing accounts, resulting in higher revenue realization and improved client satisfaction.
• Identified and resolved systemic issues impacting reimbursement trends in the acute care billing cycle.

Team Leadership & Support:

• Provided process support and guidance to a team of 40 billing and AR executives, ensuring adherence to SLA and quality benchmarks.
• Conducted training, audits, and performance evaluations, helping the team maintain high productivity and accuracy levels.
• Served as a key liaison between the team and management to escalate and resolve operational challenges efficiently.

Quality, Compliance & Reporting:

• Ensured compliance with HIPAA regulations, client-specific billing protocols, and payer guidelines.
• Generated reports to track AR trends, denial metrics, escalation cases, and team KPIs for regular review with leadership.

• Acute care hospital billing expertise
• US RCM process knowledge (AR, denials, follow-up)
• Team mentoring and leadership
• Escalation management and resolution
• Strong communication and analytical skills
• Payer policy knowledge and appeal strategies
• Proficiency in billing tools and EHR/EMR systems

Key Responsibilities:

Accounts Receivable Follow-Up (AR):

• Conducted timely and thorough follow-up on outstanding claims submitted under the California Medi-Cal (Medicaid) ambulance billing process.
• Engaged with state Medicaid representatives and clearinghouses to resolve unpaid or delayed claims.
• Prioritized claims by age and dollar value, reducing AR days and improving cash flow.

Denial Management & Resolution:

• Reviewed and analyzed denial reasons such as eligibility issues, documentation gaps, or authorization requirements specific to Medi-Cal.
• Submitted corrected claims, appeals, and supporting documentation to overturn denials efficiently.
• Collaborated with coding and billing teams to ensure accuracy and compliance with Medi-Cal guidelines.

Performance Tracking (KRA):

• Maintained, tracked, and consistently met or exceeded personal KRAs, including claim resolution rate, first-pass resolution, and productivity benchmarks.
• Reviewed weekly/monthly performance ratings and took self-initiative to close gaps and boost results.

Communication & Escalation Support:

• Maintained clear, timely, and professional communication with internal teams and external payers.
• Acted as a point of escalation for complex claims, facilitating quicker resolution through direct follow-ups.

Process Improvement & Trend Reporting:

• Proactively identified recurring trends and root causes for denials or delays and shared insights with management.
• Recommended actionable improvements in documentation, billing practices, and payer engagement strategies.
• Played a key role in minimizing future denials and improving first-pass claim acceptance.

• Specialized knowledge of Medi-Cal ambulance billing (California Medicaid)
• Strong background in AR follow-up and denial resolution
• Excellent written and verbal communication skills
• Consistent KRA tracking and self-performance analysis
• Ability to identify trends and recommend resolutions
• Detail-oriented with a proactive and team-first attitude
• Proficient in billing software, EHR platforms, and Microsoft Excel

Key Responsibilities:

Accounts Receivable Follow-Up:

• Conducted outbound calls to insurance companies (commercial and government payers) to check the status of submitted claims.
• Followed up on unpaid or underpaid claims to ensure prompt payment and minimize outstanding receivables.
• Resolved issues such as pending documentation, incorrect billing details, or coordination of benefits.

Denial Management:

• Reviewed Explanation of Benefits (EOBs) and denial codes to determine the cause of payment delays.
• Collaborated with internal teams (billing, coding) to correct and resubmit claims or submit appeals when necessary.
• Documented all denial reasons and outcomes in the billing system for future reference and compliance.