Claim specialist with total 5 years of experience in health care. Experience in Accidental claims, Sickness claims, Wellness claims and cross over policies. Focused & Goal driven with strong work ethics, striving for improvement coupled with commitment to offer quality work.
Hi, I’m
Rahul Gambhir
Summary
Overview
6
years of professional experience
Work History
R1 RCM Pvt LtdNoida
Senior Analyst
02.2023 - Current
Job overview
- Working as credit balance specialist for both patient and insurance (Government/commercial) payments.
- Improved client satisfaction by promptly identifying and resolving credit balance issues.
- Boosted productivity by leveraging advanced software tools for efficient data entry and analysis.
- Managed high volume caseloads with exceptional attention to detail, ensuring timely resolution of all credit balance cases.
- Contributed significantly towards meeting annual performance metrics by consistently exceeding individual targets.
- Reduced errors in account reconciliation, ensuring accurate credit balances for all clients.
- Monitored changes in payer requirements, adjusting billing practices accordingly to minimize disruptions in the revenue cycle.
- Reduced errors in medical billing by meticulously reviewing patient records and ensuring accurate coding.
CHCS India Pvt. Ltd ( Takeover By Capgemini)
Sr. Process Associate (Claim specialist)
09.2021 - 02.2023
Job overview
- Completed client requests and advised supervisors of special needs
- Reviewed patient diagnosis codes to verify accuracy and completeness
- Reviewed patient records, identified medical codes
- Ensured proper submission of workers comp and MVA claims
- Verified proper ICD-10 coding on claims
- Prepared statements for patients and verified correct diagnostic coding
- Complied with all HIPAA Privacy and Security Regulations to protect patients' medical records and information
- Verified signatures and checked medical charts for accuracy and completion
- Filed and updated patient information and medical records
- Ensuring that quality percentage is met on a monthly basis by conducting regular refresher training sessions and feedback
- Do 100% audits for the Team to avoid any financial leakage
Capgemini India Pvt. Ltd
Process Associate
06.2019 - 03.2021
Job overview
- Evaluated individual medical questionnaire and there various medical condition and rated them based on ICD 10
- Completed client requests and advised supervisors of special needs
- Reviewed patient diagnosis codes to verify accuracy and completeness
- Reviewed patient records, identified medical codes
- Ensured proper submission of workers comp and MVA claims
- Verified proper ICD-10 coding on claims
- Prepared statements for patients and verified correct diagnostic coding
- Complied with all HIPAA Privacy and Security Regulations to protect patients' medical records and information
- Verified signatures and checked medical charts for accuracy and completion
- Filed and updated patient information and medical records.
Genpact India Pvt. Ltd
Process Associate
03.2018 - 06.2019
Job overview
- We work for worker compensation claim insurance
- Worked in a fast-paced environment as member of process management team
- Involved in identifying and tracking overpayment opportunities by reviewing the complete claim process
- Actively reviewing provider contracts and analyzing historical overpayment trends
- First contact point for internal queries within the team, responsible for resolving them in a timely manner without affecting productivity
Education
Delhi University
Bachelor of Commerce
07.2014 - 5 2017
University Overview
Central Board of Secondary Education
Intermediate
University Overview
GPA: 74
Central Board of Secondary Education
Matriculate
University Overview
GPA: 80
Skills
Willing to take ownership and deliver resultsPersonal DetailsFather name: Mr Vimal GambhirDate of Birth : 27/09/1997Nationality: Indian
Timeline
Senior Analyst
R1 RCM Pvt Ltd
02.2023 - Current
Sr. Process Associate (Claim specialist)
CHCS India Pvt. Ltd ( Takeover By Capgemini)
09.2021 - 02.2023
Process Associate
Capgemini India Pvt. Ltd
06.2019 - 03.2021
Process Associate
Genpact India Pvt. Ltd
03.2018 - 06.2019
Delhi University
Bachelor of Commerce
07.2014 - 5 2017
Central Board of Secondary Education
Intermediate
5 2014
Central Board of Secondary Education
Matriculate
5 2012