Job Search Status
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Open To Work
Rajesh Mishra
New Delhi
Work Preference
Summary
Results-driven Quality Specialist with 9+ years of experience in healthcare revenue cycle management. Adept at auditing, denial management, SOP development, and performance improvement. Proven track record of driving operational excellence and mentoring high-performing teams. Recognized for impactful insights and strategic planning that enhance compliance and reduce errors.
Overview
10
10
years of professional experience
Work History
Quality Specialist
R1 RCM Global Private Limited
06.2021 - Current
- Created audit and sample plans, shared feedback, and trained team members weekly on identified themes.
- Evaluated processed claims for errors and compliance, and provided actionable feedback.
- Preparing weekly quality insights and sharing it with management.
- Conducted audits for Onshore and BSO teams to ensure compliance with standards.
- Doing Knowledge transfer to auditors and completing their certification.
- Managing escalations received externally and internally and sharing the plan of action for improvement.
- Prepared detailed error trend analysis with root causes, and communicated performance improvement plans to ops and QA teams.
- Completed various tasks and responsibilities based on project needs.
Sr. Analyst
R1 RCM Global Private Limited
09.2017 - 06.2021
- Oversaw denial resolution efforts to ensure timely and accurate claims processing.
- Initiated appeals for cases referred by AR follow-up and onshore client via E-pars and PAS Portal, utilizing previous follow-ups and available remittance to drive resolution.
- Mentored new joiners, conducted comprehensive audits of claims processed, and provided monthly progress reports to management.
- Requested and reconciled medical records.
Senior AR Associate
NTT DATA formerly Dell Services
04.2016 - 09.2017
- Managed aging process and resolved denied claims to improve collection outcomes.
- Verified insurance information for denial claims to ensure accurate processing and minimize discrepancies.
- Posted rejections and wrote off balances per provider agreement to maintain compliance.
Education
M.COM -
Delhi University
Delhi08-2014
B. Com -
Delhi University
DelhiSkills
- Quality Auditing & Error Analysis
- SOP & Training Material Development
- Claims Evaluation & Denial Management
- Performance Improvement Planning
- Project Planning & Sampling
- Team Mentoring & Knowledge Transfer
- Escalation management
Accomplishments
• Received R1 star of the Quarter from past 3 quarters (April 25-Dec 25).
• Received Quality Excellence award in June 2024 for sharing smart observation having impacted amount of 1.2 million dollars.
• Received Quality Excellence award in June 2024 for sharing smart observation having impacted amount of 1.2 million dollars.
Hobbies and Interests
- Singing
- Cooking
- Travelling
Personal Information
- Date of Birth: 10/02/91
- Gender: Male
- Nationality: Indian
- Marital Status: Married
- Religion: Hindu
Languages
- English
- Hindi, Professional
- English, Full Professional
Timeline
Quality Specialist
R1 RCM Global Private Limited
06.2021 - Current
Sr. Analyst
R1 RCM Global Private Limited
09.2017 - 06.2021
Senior AR Associate
NTT DATA formerly Dell Services
04.2016 - 09.2017
M.COM -
Delhi University
B. Com -
Delhi University