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
undefinedAccomplishments
- 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
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