Raghavendra Papetla
Director - Healthcare Operations
Secunderabad
Summary
- Seeking assignments in Customer Service / Process Management (Collections & Claims) with a reputed organization.
- A dynamic professional with 16 years of experience in US Healthcare, Process Management, Process Validation & Relationship Management
- Good exposure in coordinating with team members, forging relations, People Management & providing customized services.
- Collating, analyzing and reporting of information crucial for enhancements in the process and the overall growth of the organization.
- Identify and execute effective result oriented processes as per Client SLAs
- An out of the box thinker with exceptional communications, relationship management and analytical skills.
- Coordinating with cross-functional teams to meet client requirements like billing, cash posting.
- Identify and analyze the problem for less cash and Accounts Receivable movement on the project
- Identified the trends and issues of the insurance companies regarding the reimbursements and payments
- Can handle multiple process
- Worked on UB04 claim & CMS 1450 form (Hospital projects)
- Quick-thinking Supervisor recognized for success in guiding teams and boosting performance.
- Practical problem-solver with excellent issue and conflict resolution skills to drive team and organizational success.
- Highly effective and knowledgeable in process improvement and inventory control.
Overview
18
18
years of professional experience
Work History
Director (Operations - Revenue Cycle Management
GeBBS Healthcare Solutions Pvt. Ltd
3 2023 - Current
- Ensure client's SLA is met including service delivery, timely report and quality control
- Currently spearheading a span of 700+ FTEs on Account receivables (AR-RCM), Ensure customer policies, procedures and contractual agreements are consistently met without any deviation
- Provide strategic guidance to operations managers to ensure service delivery
- Creating BOT for Different processes to increase efficiency of process at reduced cost
- Responsible to meet AOP for the project handling.
- Established a culture of continuous improvement by fostering open communication channels and empowering employees to voice their ideas
- Proactively identified potential risks and implemented mitigation strategies to minimize negative impacts on projects or business operations
- Managed daily operations while overseeing multiple locations to foster increased productivity
- Increased company revenue by streamlining processes and implementing cost-saving measures
- Established departmental performance goals and provided feedback for underperforming areas
- Implemented innovative solutions to solve complex problems, resulting in increased productivity and streamlined operations
- Managed budgets effectively to ensure optimal use of resources while maintaining financial stability
Portfolio Leader (Director) (Operations - Revenue Cycle Management
Inventurus Knowledge Solutions Pvt. Ltd
05.2021 - 02.2023
- Ensure client's SLA is met including service delivery, timely report and quality control
- Ensure effective communication with the client on project & the issue faced by the client is resolved
- Weekly/Monthly issue trackers to be shared with the clients with the probable solutions to eradicate/reduce the issues impacting the business
- Ensure Billing and Posting Recon logs are shared with the Client on Daily basis and raise a red flag for any issues, which may impact the collection
- Ensure Payment Variances/CPNP Trackers/Weekly/Monthly reports with the RCM Dashboard reaches to the client projecting the trends
- Monthly Business Review with the client to discuss the Account Performance/Challenges and setting up the goals to meet End Client Requirement
- Work closely with the Client and be the first level of escalation point
- Ensure month end Invoices are sent to the Client as per the contracted price.
Senior Manager (Operations - Revenue Cycle Management)
Pacific BPO Pvt. Ltd. - An AccessHealthcare Company
01.2019 - 05.2021
- Manage end to end operations of client, with core goal of meeting/expecting client expectations
- Suggest and implement staffing requirements to ensure utmost contribution to revenue
- Prepare reporting's related to Monthly Business Review, including inventory performance, staffing & analysis and Executive reports for clients
- Recommend procedural changes to improve Contribution Margin & Resource Utilization and Decrease attrition
- Recommend Potential Automation, to improve Project Performance & Client Satisfaction
- Promote Business Opportunity to Current Clients
- Lead transition of new projects
- Conduct weekly review with all clients to showcase Project performance and discuss challenges
- Conduct weekly review meetings with Team Leaders/Assistant Managers, to discuss Project Performance
- Recommend procedures to Team Leaders to improve team/team member's performance
- Recommend performance recognitions
- Participate in performance reviews
- Groom immediate reporting Managers to Up-skill Knowledge
- Assist Recruitment team in hiring process for the project/BU.
Manager (Operations - Revenue Cycle Management
Inventurus Knowledge Solutions Pvt. Ltd
01.2017 - 12.2018
- Ensure client's SLA is met including service delivery, timely report and quality control
- Ensure effective communication with the client on project & the issue faced by the client is resolved
- Weekly/Monthly issue trackers to be shared with the clients with the probable solutions to eradicate/reduce the issues impacting the business
- Ensure Billing and Posting Recon logs are shared with the Client on Daily basis and raise a red flag for any issues which may impact the collection
- Ensure Payment Variances/CPNP Trackers/Weekly/Monthly reports with the RCM Dashboard reaches to the client projecting the trends
- Monthly Business Review with the client to discuss the Account Performance/Challenges and setting up the goals to meet End Client Requirement
- Work closely with the Client and be the first level of escalation point
- Ensure month end Invoices are sent to the Client as per the contracted price.
E-Clinical works - Team Leader
04.2015 - 12.2016
- Assignment of work to the team on a daily basis
- Conducting meetings with AMRC and AH Team to discuss the client requirements
- Coordinating with cross-functional teams like billing, cash posting on daily basis
- Maintaining Issues Log on the project & conducts by Weekly meetings to discuss the same
- Identify and analyse the problem for less cash and Accounts Receivable movement on the project
- Grooming Mentors for next level
- Identifying the trends and issues of the insurance companies regarding the reimbursements and payments
- Identifying GAP's in the system and fix it to minimal the rejection %age
- Creating rules in the system which reduces the avoidable denial %age
- Deploying practice specific rules in the system
- Identifying the reasons for multiple touches on claims and ensure that the follow up is done accurate
- Involving the QA's in practice specific issues to get the resolution in faster pace
- Coordinating with AMRC's for practice specific issues
- Responsible for Getting CMR & CFRA signed from the practices
- Presenting Business review on monthly basis to the team and Manager
- Conducting one on one sessions on monthly basis
- Responsible for all the reporting for the respective POD.
Infinx Services Pvt Ltd - SR. Team Leader
05.2014 - 02.2015
- Assignment of work to the team on a daily basis
- Conducting client meetings and conference calls to discuss the client requirements
- Coordinating with cross-functional teams like billing, cash posting
- Maintaining Issues Log on the project & conducts by Weekly meetings to discuss the same
- Identify and analyze the problem for less cash and Accounts Receivable movement on the project
- Grooming Sr
- Reps to handle responsibilities like maintaining Attendance & Leave log, updating transport, downtime for project, and reporting Productivity for the Team
- Identifying the trends and issues of the insurance companies regarding the reimbursements and payments.
Sutherland Healthcare Solutions - Team Leader
03.2008 - 09.2013
- Assignment of work to the team on a daily basis
- Conducting client meetings and conference calls to discuss the client requirements
- Coordinating with cross-functional teams like billing, cash posting
- Maintaining Issues Log on the project & conducts by Weekly meetings to discuss the same
- Identify and analyze the problem for less cash and Accounts Receivable movement on the project
- Grooming Sr
- Reps to handle responsibilities like maintaining Attendance & Leave log, updating transport, downtime for project, and reporting Productivity for the Team
- Identifying the trends and issues of the insurance companies regarding the reimbursements and payments
- Providing monthly performance feed backs for the Team
- Based on Client requirement completing the assigned work before TAT
- Maintaining Team performance as per the standard SLA's
- Ensuring the team reaches the productivity on daily basis
- Responsible for creating updates and training new hires on the client system & Process flows
- Responsible for resolving complex high dollar accounts
- Responsible for conducting Team Meeting for Productivity and Quality
- Forwarding Weekly reports to the Client and NBO Team
- Process Audits on the project
- Rotating job roles or additional responsibilities for team members to keep them motivated and overcome job monotony
- Worked independently on making ISO documents.
Zavata India Pvt Ltd - SR Process Associate
04.2006 - 11.2007
- Responsible for meeting the individual productivity & accuracy target
- Handled the responsibility of Transport Spoc & updated the roster for all the process employees
- Responsible for sharing updates with the team on regular basis.
Education
Skills
Hiring and Onboarding
Process Improvements
Contract and Vendor Management
Policy Development and Enforcement
Cost Control
KPI Tracking
Goal Setting
Accomplishments
- Reduced attrition with effective career counselling
- Increased team productivity to >40 claims/day by strategizing follow up based on individual portfolio status, Eg: Svc types, Trend analysis, Insurance types, etc.
- Retained and developed employees undergoing PIP by effective follow up and feedback
- Recognized agents areas of concern and equipped them to reach their full potential
- Effectively reduced repetitive and redundant follow up by analyzing trends and portfolio patterns
- Ensured compliant and contractual payments with detailed contract study and reducing variances between client, Indian Office and payers
- Understand US client requirements and overcome Indian cultural differences to meet client expectations.
- With effective team bonding techniques was able to best use available manpower with their individual potentials
- Reduces FTE's on the process by introducing new concepts, changing method of assignment, providing trends for follow-up and identifying problems well in advance.
- Received Best team Award for Christ project and Kingsbrook
- Received award for good Quality and Productivity for more than 10 months.
- Team issues and concerns have been handled at first level escalation.
References
References on request.
Timeline
Portfolio Leader (Director) (Operations - Revenue Cycle Management
Inventurus Knowledge Solutions Pvt. Ltd
05.2021 - 02.2023
Senior Manager (Operations - Revenue Cycle Management)
Pacific BPO Pvt. Ltd. - An AccessHealthcare Company
01.2019 - 05.2021
Manager (Operations - Revenue Cycle Management
Inventurus Knowledge Solutions Pvt. Ltd
01.2017 - 12.2018
E-Clinical works - Team Leader
04.2015 - 12.2016
Infinx Services Pvt Ltd - SR. Team Leader
05.2014 - 02.2015
Sutherland Healthcare Solutions - Team Leader
03.2008 - 09.2013
Zavata India Pvt Ltd - SR Process Associate
04.2006 - 11.2007
Director (Operations - Revenue Cycle Management
GeBBS Healthcare Solutions Pvt. Ltd
3 2023 - Current