Pratik Ogale

• Revenue Cycle Management

End-to-end RCM process management

Claims submission and processing

Billing and coding (CPT, ICD-10, HCPCS)

Denial management and appeals

Payment posting and reconciliation

Accounts receivable management

• Regulatory Compliance

Knowledge of HIPAA regulations

Understanding of payer/provider rules and healthcare regulations

Compliance with Medicare, Medicaid, and private insurance guidelines

• Data Analysis & Reporting

Financial reporting and analytics

KPIs and metrics tracking (eg, Days in A/R, Collection rates)

Revenue cycle performance improvement

Use of RCM software and tools (eg, Epic, Cerner, Athenahealth)

• Leadership & Team Management

Managing and mentoring RCM teams

Cross-functional collaboration with clinical, IT, and finance teams

Workflow optimization and team productivity enhancement

Training and development of billing and coding staff

• Process Improvement & Optimization

Process re-engineering and automation

Implementation of best practices for claims processing and collections

Reducing revenue cycle inefficiencies

Experience with Lean other process improvement methodologies

• Patient Financial Services

Managing patient billing inquiries and complaints

Patient collections and financial counseling

Insurance verification and eligibility checking

• Technology & Software

Experience with RCM software platforms (eg, Epic, eClinicalWorks, NextGen)

Proficiency with practice management systems and EHRs

Knowledge of automation tools (eg, RPA for claims processing)

Data management and reporting using AI Advanced Excel, Tableau, or Power BI

• Stakeholder Communication & Negotiation

Liaison with payers, providers, and internal stakeholders

Negotiating payment terms and resolving disputes

Strong verbal and written communication skills

• Project Management

Leading RCM-related projects

Implementing new systems or upgrades

Timeline and budget management