Omkar Biradar

Results-driven Team Leader with 5+ years of progressive experience in the US Healthcare Revenue Cycle Management (RCM) domain, specializing in hospital and professional billing, denial prevention, and AR optimization. Proven track record of leading high-performing teams, driving operational excellence, and improving revenue realization through strategic process enhancements. Adept at managing end-to-end revenue cycle functions, implementing data-driven performance strategies, and ensuring compliance with payer regulations and HIPAA standards.

Demonstrated success in reducing AR aging, increasing clean claim rates, and minimizing denial recurrence through root cause analysis and workflow transformation initiatives. Strong stakeholder management skills with experience coordinating cross-functional teams, mentoring staff, and presenting KPI dashboards to senior leadership. Recognized for delivering measurable improvements in productivity, quality metrics, and overall financial performance.

Projects Summary Project # 1:

Project : Claims Analyst

Client : East Tennessee State University Environment: RCM Denial ManagementDuration : Oct 2019 –

Sept 2020.

Project Description:

ETSU has a application called All scripts Software from which we would get the claims as processed or

denied. Based on the claim status I should call to the specific payer to which the claim has been sent

andenquire about the denials. Later, should analyse the denial and take anproper action as per the

denial and make the claims process and generate the revenue.

Roles and Responsibilities:

• I as an AR Caller work on claims that were sent to the payerfrom provider for the re- imbursement

for the services provided to the member.

• I work on denial management.

• I work on Eligibility verification, Coding denials, Authorizationdenials.

• I work on coding denials about CPT Codes, Diagnosis codesand modifiers.

• Updated the status & Performed project delivery work.

• Involved in Status meetings with Client.

• the team members

Project # 2

Project : Availity

EDI

Molina Health Care

Client : Molina Health CareEnvironment: Citrix

Duration : September 2021- March 22nd 2023

Project Description:

This project where we test all groups in which we find all healthcare service benefits because

whenever there is a group renewals going on yearly, half-yearly and quarterly basis there will be

change in benefitcoding. Here in this case Group benefits are being changed. So, thepurpose of this

project is to test

whether groups are hitting with correct benefits or not. If any defect identified in execution of test

cases then raise the ticket.

Roles and Responsibilities:

• Validating the Group Information in Production.

• Involved in testing the coded string behavior in Model officeenvironment.

• Taking the screenshots of the processed data by running Macros.

• Responsible for Bug Reporting, Tracking and Documentation usingCQ.

• Execution of test cases by validating the Claims.

• Also working as an Offshore Quality Analyst.

• Reviewing the test results before it is publishing to Onsite/Client. Any issue identified in test case

execution, then raise the defectto coding team and getting it corrected.

• Involved in Status meetings with Client.

• Updated the status & Performed project delivery work

Project : ITS [Interplan Teleprocessing System]

Duration : July 2023- june 16th 2025

Project description

the processing of healthcare claims (both paper and electronic) through a

defined workflow, ensuring accurate adjustments onon the claims in

ocwa and B2, research of claims enrollment and eligibility verification,

especially during group benefit renewals.Receive claims in various

formats: CMS-1500, UB-04, HCFA 1500.Enter claims into the OSCAR

system.

Initiate a mini enrollment process for the claims.Validate the claims to

ensure all necessary information is accurate and complete.

Conduct pre-enrollment checks to prepare for provider enrollment.

Ensure that all claims are processed in compliance with healthcare

regulations and standards.

we use service now tool,Owca(Oscar claims web applications)

whether groups are hitting with correct benefits or not. If any defect

identified in execution of claims we Seek help of developers then it

moved to Product Engineer Team

Roles and Responsibilities:

Validating the Group Information in Production.

Involved in testing the coded string behavior in Model office

environment.

Analyze denials to determine underlying causes (coding errors, missing

documentation, eligibility issues, authorization lapses)

Monitored daily operations, ensured adherence to SLAs (turnaround time,

accuracy, productivity), and resolved escalations.

Training, Mentoring & Knowledge Transfer

Supervised new associates handling claims adjudication, adjustments,

and appeals for US health insurance clients