Mohammed Basarat Pasha
Manager - RCM Operations
Hyderabad
Summary
With over 10 years of experience in managing the revenue cycle for home health care and DME claims, including denial resolution, modifier management, and payment posting through EMR/EHR systems. Skilled in using payer portals and clearinghouses (Inovalon, Basis, Brightree) for compliance and reimbursement. Proficient in securing authorizations, addressing rejections, and optimizing SLAs, with a proven 95%+ success rate in overturning denied claims.
Overview
17
17
years of professional experience
2010
2010
years of post-secondary education
2
2
Certifications
3
3
Languages
Work History
Manager - RCM Operations
DST Worldwide services
04.2015 - 01.2023
- Understanding claim denials and resubmitting or adjusting claims by identifying resolutions or appealing through the payer portal within the time limits, while following up on payment.
- Creating dashboards to ensure timely receipt of all payments, with follow-up on any pending payments
- Handle the appeal process for denied claims, working diligently to secure payments from payers. Our success rate in overturning denials and obtaining payments is consistently above 95%
- DME Modifier Management
- Ensure correct use of modifiers ("RR" for rentals, "NU" for purchases) on claims. Resolve modifier-related denials and submit corrected claims. Collaborate with payers for compliance and reimbursement accuracy. - Utilized various portals for appealing home health care and DME claims, including Palmetto, MyCGS, Carelon, Caresource, Availity, UHC Portal, UMR Portal, Optum, and Medicaid.
- Hands-on experience with clearinghouse platforms like Inovalon, Basis, and Brightree involves efficiently submitting, tracking, and managing claims in compliance with payer and regulatory requirements, including addressing rejected claims, utilizing tools for eligibility checks, and ensuring accurate processing of home health care and DME claims for reimbursement, with a strong understanding of revenue cycle management, claims submission, and denial resolution being crucial.
- Managed Medicare RTPs (Return to Provider) and resolved issues to ensure timely payment was received.
- Obtained authorizations for home health care and DME services to minimize claim denials and expedite reimbursement.
- Timely posted payments for home health care and DME billing through EMR/EHR systems, and proactively resolved claim denials to ensure prompt reimbursement.
- Coordinated with all RCM departments (authorization, claim submission, denial management, and payment posting) to ensure compliance, meet SLAs, and optimize TAT.
- Possess strong hands-on experience with Brightree, Basis, and Inovalon for efficient claims processing and management.
Sr. - Claims Examination/Claims Adjudicator
Optum Global Solutions
03.2013 - 04.2015
- Process claims that route out of automatic adjudication within current turnaround standards with efficient productivity and Quality measurements
- Analyze and identify trends and provide reports as necessary.
- Followed up with customers on unresolved issues.
- Analyzed and addressed escalated claims to resolve issues quickly.
Sr. Process Executive
DST Worldwide services
09.2010 - 03.2013
- The Process involves verifying supporting documents like Provider License, Plan of Care, Daily Visit Notes, Continued Monthly Rent (CMR), HCFA, UB/92 and others
- As a specialist received authority to examine claims up to $9000/claim for approvals and denials $15000 within a span of 6 months
- Authorized to do Examination QA(Quality Audit)
Quality Assurance Executive
First Indian Corporation Private Limited
05.2006 - 06.2008
- Quality checking of database on integrated mainframe system that delivers property ownership and history, tax assessment & payment data recorded document images using Data Trace System
- Daily preparing Exceptional Reports while on Quality Check
- Upgrading of database using Netterm & Exceptional Reports
- Providing Scan Response for the Data Processing Executives & other executives daily
- Daily Interaction with the Processing Executives, Verifiers & other Executives regarding the new amendments.
Education
B.Com - Commerce
Dr. B.R. Ambedkar Open University
Skills
Performance Evaluations
Staff Training and Development
Performance Management
Complex Problem-Solving
Team Leadership
Time Management
Certification
CBQA (Certified BPO Quality Analyst)
Accomplishments
- Led my team to achieve a 95%+ appeal success rate, consistently overturning claim denials and ensuring timely reimbursement.
- As a startup process, cleared the backlog of home health care denials by appealing claims, securing payments, and streamlining the project for improved operational efficiency.
- IPQA (Internal Process Quality Assurance)
Timeline
Manager - RCM Operations
DST Worldwide services
04.2015 - 01.2023
Sr. - Claims Examination/Claims Adjudicator
Optum Global Solutions
03.2013 - 04.2015
Sr. Process Executive
DST Worldwide services
09.2010 - 03.2013
Quality Assurance Executive
First Indian Corporation Private Limited
05.2006 - 06.2008
B.Com - Commerce
Dr. B.R. Ambedkar Open University
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