RAJKUMAR SINGH
Greater Noida
Summary
Operations Manager with 12+ years of experience in US Healthcare Operations, Medical Coding, Claims Adjudication, and Fraud/Waste/Abuse (FWA). Strong expertise in managing large teams, driving SLA/KPI performance, process transitions, automation initiatives, and compliance with CMS and client-specific guidelines.
Overview
15
15
years of professional experience
Work History
Manager Operations (Medical Coding & Claims)
EXL Service
Noida
08.2025 - Current
- Leading end-to-end medical coding and claims operations ensuring compliance with CMS, payer, and client-specific policies.
- Managing productivity, quality, TAT, SLA adherence, and capacity planning.
- Conducting coding accuracy audits (CPT, ICD-10-CM/PCS, HCPCS) and driving corrective actions.
- Supporting process transitions, migrations, stabilization, and automation initiatives.
- Reviewing complex and high-value claims to identify upcoding, unbundling, duplication, and medical necessity issues.
- Preparing MIS, trend analysis, and executive dashboards for leadership and onshore stakeholders.
Deputy Manager Training
Optum
03.2025 - 08.2025
- Designed and executed training strategies aligned with US Healthcare operations and coding.
- Conducted training needs analysis and developed targeted learning interventions.
- Led onboarding, upskilling, and certification-focused training programs.
- Partnered with operations and quality teams to improve performance and compliance outcomes.
Senior Operations Trainer
Optum
11.2021 - 02.2025
- Managed a team of experienced trainers delivering new hire and refresher trainings.
- Delivered clinical investigation and medical coding trainings based on CPT & HCPCS coding.
- Delivered multiple CPC certification batches with 100% throughput.
- Conducted needs assessments and implemented performance improvement initiatives.
- Developed onboarding programs and instructional design content.
Subject Matter Expert (SME) – Clinical Investigation (Payment Integrity)
Optum
03.2016 - 10.2021
- Monitored team performance against quality and productivity metrics.
- Developed training guidelines, SOPs, assessments, and reference materials.
- Participated in client connects, calibrations, and escalation management.
- Implemented cost-saving initiatives and process improvements.
Clinical Investigator
Optum
07.2013 - 02.2016
- Prevented payment of fraudulent and abusive claims using CPT, ICD, and CMS guidelines.
Senior Medical Associate (Medical Summarization)
Innodata Isogen Pvt. Ltd.
01.2012 - 06.2013
- Reviewed and summarized medical records; assigned ICD-10 codes.
Physiotherapist
A5 Health Solutions Pvt. Ltd.
04.2011 - 12.2011
- Conducted physiotherapy assessments and treatment planning.
- Delivered health counselling in corporate camps and health fairs.
Education
AAPC – CPC Certified -
BPT - Physical Therapy
ITS Paramedical College
GhaziabadSkills
- Clinical and Non-Clinical Process Operations
- Process Enhancement
- Automation
- Standardization
- Client Relationship Management
- Goal Setting
- Strategy Planning
- Training
- Employee Grooming
- Process Migration
- Pilot
- Stabilisation
- MIS Reporting
- Data Management
- Clinical Investigation
- Payment Integrity
- Medical Coding
- Claims Processing
- Adjudication
Accomplishments
- Supervised teams of up to 22 FTEs.
- Trained 100+ clinicians for Payment Integrity processes.
- Trained 50+ associates for CPC certification.
- Implemented RPA initiatives resulting in productivity improvement.
- Traveled across geographies for training and process setup.
Languages
- English
- Hindi
- English
Languages
English
Advanced
C1
Hindi
Proficient
C2
Timeline
Manager Operations (Medical Coding & Claims)
EXL Service
08.2025 - Current
Deputy Manager Training
Optum
03.2025 - 08.2025
Senior Operations Trainer
Optum
11.2021 - 02.2025
Subject Matter Expert (SME) – Clinical Investigation (Payment Integrity)
Optum
03.2016 - 10.2021
Clinical Investigator
Optum
07.2013 - 02.2016
Senior Medical Associate (Medical Summarization)
Innodata Isogen Pvt. Ltd.
01.2012 - 06.2013
Physiotherapist
A5 Health Solutions Pvt. Ltd.
04.2011 - 12.2011
AAPC – CPC Certified -
BPT - Physical Therapy
ITS Paramedical College