Rajdeepsinh Gohil
Account receivable specialist
Ahmedabad
Summary
Detail-oriented Accounts Receivable & Verification Specialist with 4+ years of experience in U.S. healthcare RCM. Proficient in insurance eligibility verification, patient responsibility estimation, AR follow-up, and denial management. Skilled in working with commercial insurance plans, Medicare, and Medicaid to ensure accurate claim submission and timely reimbursement. Adept at collaborating with payers, providers, and patients to enhance revenue recovery, prevent claim rejections, and deliver excellent customer service.
Overview
4
4
years of professional experience
Work History
Account Receivable & Eligibility Verification Specialist
Analytix Solutions
11.2024 - Current
- - Perform insurance eligibility and benefits verification across Medicare, Medicaid, and commercial plans to ensure accurate coverage details before claim submission.
- - Accurately calculate patient responsibility (copay, deductible, coinsurance, OON benefits) to support upfront collections and minimize denials.
- - Manage accounts receivable processes, including claim follow-up, payment posting, and denial resolution, ensuring timely reimbursement.
- - Investigate and resolve coverage or payment discrepancies, improving clean claim rates and cash flow.
- - Collaborate with internal teams to streamline verification and AR workflows, enhancing revenue cycle efficiency.
- - Provide guidance and training to team members on payer portals, verification processes, and denial prevention.
Eligibility & Benefits Verification Specialist
Contva Care Solution
01.2024 - 10.2024
- - Performed comprehensive eligibility and benefits verification for Medicare, Medicaid, and commercial insurance plans prior to patient services.
- - Accurately determined patient financial responsibility (deductibles, coinsurance, copays, OON benefits) to ensure upfront collection and reduce billing issues.
- - Verified coverage for various healthcare services, including inpatient, outpatient, and telehealth.
- - Investigated and resolved coverage discrepancies, preventing claim rejections and reducing denials.
- - Communicated benefits and patient responsibility details to providers, billing teams, and patients for transparent financial counseling.
- - Utilized payer portals and clearinghouses efficiently to streamline verification processes and improve turnaround time.
Payment Posting Associate
Shukla Information Solution
02.2023 - 12.2023
- - Posted and reconciled insurance and patient payments with high accuracy.
- - Identified discrepancies in payment postings and ensured corrective actions.
- - Maintained precise AR records for seamless claim follow-up.
Payment Posting Associate
Fedora Solution
05.2021 - 01.2023
- - Processed insurance and patient payments in compliance with RCM standards.
- - Conducted account reconciliations, reducing outstanding balances.
- - Supported AR management by maintaining accurate posting workflows.
Education
Master of Commerce - Finance
K.R. Doshi Group of Colleges
01.2020
Bachelor of Commerce - Finance
K.R. Doshi Group of Colleges
01.2018
Skills
- - Insurance Eligibility & Benefits Verification (Medicare, Medicaid, Commercial)
- - Patient Responsibility Estimation (copay, coinsurance, deductible)
- - Revenue Cycle Management (RCM)
- - AR Management & Denial Prevention
- - Medical Billing Software Proficiency
- - Communication & Customer Service
- - Analytical & Problem-Solving Skills
- - Quality Assurance & Compliance
Timeline
Account Receivable & Eligibility Verification Specialist
Analytix Solutions
11.2024 - Current
Eligibility & Benefits Verification Specialist
Contva Care Solution
01.2024 - 10.2024
Payment Posting Associate
Shukla Information Solution
02.2023 - 12.2023
Payment Posting Associate
Fedora Solution
05.2021 - 01.2023
Bachelor of Commerce - Finance
K.R. Doshi Group of Colleges
Master of Commerce - Finance
K.R. Doshi Group of Colleges
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