Summary
Overview
Work History
Education
Skills
Core Competencies
Personal Information
Languages
Hobbies and Interests
Additional Qualifications
Timeline
Generic
RAJESH GAWADE

RAJESH GAWADE

Kalyan

Summary

To leverage my expertise in Revenue Cycle Management (RCM) and operations to drive organizational success and profitability. Possess 19 years of experience in the healthcare industry, including 11 years of managing operations in U.S. Revenue Cycle Management (RCM). Proficient in client communication, system analysis, and milestone planning, serving as a critical escalation point for addressing complex issues. Comprehensive knowledge of end-to-end RCM processes. Skilled at team leadership, aligning employee objectives with corporate goals to ensure efficiency and success. A Certified Professional Coder (CPC) since 2013, with an in-depth understanding of medical coding across multiple specialities.

Overview

19
19
years of professional experience

Work History

Senior Manager - Coding

Harris Computer
01.2022 - Current
  • Oversee the coding and billing processes, ensuring accuracy and compliance
  • Lead initiatives to minimize claim rejections and ensure submission of clean claims
  • Implement client-centric solutions for specialties like Internal Medicine, Pediatrics, OB-GYN, and more
  • Handling team of 60+ people from Coding & BIlling domains

Manager – Coding

Bizmatics India Pvt. Ltd
01.2019 - 01.2022
  • Directed full-spectrum coding and billing operations
  • Established rejection-handling protocols and delivered optimal results for high-profile clients
  • Supported the implementation of advanced coding tools and technologies to streamline processes

Manager RCM

Bizmatics India Pvt. Ltd
01.2018 - 01.2019
  • Managed operations for the company’s largest client
  • Delivered measurable improvements in RCM processes and team performance

Assistant Manager RCM

Bizmatics India Pvt. Ltd
09.2013 - 01.2019
  • Company Overview: One of the Best EHR software company in US, also providing RCM services to the clients with cost effective
  • Responsible for end to end RCM process of all assigned clients
  • Responsible for Scrubbing, Payment posting, Rejections, Denials and AR process
  • Client coordination on various issues & updates
  • Meeting with US team on weekly basis
  • Weekly Billing & collection report, weekly Aging report, weekly trend analysis report
  • Generating Monthly AR analysis report, Denial Analysis report, Payment queries, Month End Reports for the Clients
  • On Boarding New Client’s protocol as per SLA
  • Understanding Clients requirement & helping the team to execute it
  • Handled one of the biggest client for the organization
  • Target setup for the team monitoring its execution
  • Execution of the new project & streamline it
  • Setup quality parameter for the team
  • Preparing SOPs & documents for understanding
  • Handling team of 30+ people from various domains

Medical Billing (Mentor)

eClinicalWorks India Pvt. Ltd.
03.2010 - 08.2013
  • Handling a team of 8 people who belong to different domains in RCM.
  • Doing QC of all the domains, i.e.,
  • Coding, Payment Posting, Patient Statement, and AR.
  • Assigning the work among the team, and sharing updates that are received from clients.
  • Mail conversation and sometimes having calls with the clients regarding process-related queries.

Associate – Medical Biller

Inventurus Knowledge Solutions India Pvt. Ltd.
11.2007 - 02.2010
  • Working as a Payment Posters
  • Doing audits of payment transactions which are posted by the poster in the system
  • Working in patient registration, charge entry
  • Working in Denial Management team, handling rejected claims & resolve the issue by doing proper research & resubmitting it with required documents
  • Working on correspondence

Medical Coder

R-TEC systems (I) Pvt. Ltd.
02.2006 - 10.2007
  • First 3 months doing Medical Transcription files
  • Completed training of Medical Billing and Coding
  • Working on software called MARS (medical administrative record sheet)

Education

T.Y.B Sc. -

B.N. Bandodkar College
Thane, Mumbai
01.2004

HSC -

N.K.T. College
Thane, Mumbai
01.2001

SSC -

Maharashtra Vidyalaya
Maharashtra
01.1999

Skills

  • Coding compliance
  • Claim management
  • Medical coding
  • Revenue cycle management
  • Billing reconciliation
  • Process improvement
  • Data analysis
  • Client relations
  • Operations management
  • Cross-functional team coordination
  • Conflict resolution
  • Staff development

Core Competencies

Process Management:

Monitoring overall functioning of processes, identifying improvement areas and implementing adequate measures to maximize customer satisfaction level.

Mapping client’s requirements and coordinating in developing, implementing transitioning processes in projects with the guidelines specified by the client.

Overseeing process improvement, initiative through system changes, process re-alignment/ redefining and efficient management.

Operation Management:

Setting up targets/goals for the process.

Responsible for taking steps to ramp process if necessary.

Designing process work flow methods and procedures.

Quality & Compliances:

Designing quality procedures & parameters

Ensuring that the teams adhere to all the quality tools & procedures.

Personal Information

  • Date of Birth: 05/28/82
  • Gender: Male
  • Nationality: Indian
  • Marital Status: Married

Languages

  • English
  • Hindi
  • Marathi

Hobbies and Interests

  • Traveling
  • Listening to Music
  • Playing Cricket

Additional Qualifications

  • CPC - (AAPC), 2013
  • MS Office, 2007
  • Internet Operations
  • MS-CIT Course
  • Medical Transcription Course

Timeline

Senior Manager - Coding

Harris Computer
01.2022 - Current

Manager – Coding

Bizmatics India Pvt. Ltd
01.2019 - 01.2022

Manager RCM

Bizmatics India Pvt. Ltd
01.2018 - 01.2019

Assistant Manager RCM

Bizmatics India Pvt. Ltd
09.2013 - 01.2019

Medical Billing (Mentor)

eClinicalWorks India Pvt. Ltd.
03.2010 - 08.2013

Associate – Medical Biller

Inventurus Knowledge Solutions India Pvt. Ltd.
11.2007 - 02.2010

Medical Coder

R-TEC systems (I) Pvt. Ltd.
02.2006 - 10.2007

T.Y.B Sc. -

B.N. Bandodkar College

HSC -

N.K.T. College

SSC -

Maharashtra Vidyalaya
RAJESH GAWADE