Advanced MD
Sandeep Tukaram Chandivade
Revenue Cycle Lead
Mumbai,MH
Summary
A result oriented professional with 5 year plus experience in US Healthcare into RCM‑ operations across multiple clients, states and insurances into different Projects ( Claims Processing Submission/Resubmission, Insurances, Prior‑ Authorizations, Denials and AR Follow‑ up) Hard working and sincere attitude combined with a keen interest in learning new things. Good Understanding of processes, Good analysis and interpretation skills. Proficient in managing highly efficient and skilled operational teams. Target and Achievement oriented with an ability to take up challenges and perform in changing work environments.
Overview
9
9
years of professional experience
17
17
years of post-secondary education
3
3
Languages
Work History
Revenue Cycle Lead
Revupside Business Solutions Pvt Ltd
Mumbai, Maharashtra
02.2021 - Current
- Collaborated with team members to achieve target results.
- Maintained excellent attendance record, consistently arriving to work on time.
- Created spreadsheets using Microsoft Excel for daily, weekly and monthly reporting.
- Lead a team of analysts and team coach to do AR follow. Guide team to reduce AR ageing and optimize collections.
- Perform quality check on the A/R follows or EOB denial analysis work done by the team before it is sent to the clients
- Tracking and maintaining metrics for a variety of data includes attendance, productivity, etc
Quality Analyst
Viaante BusinessSolutions PvtLtd
Mumbai, Maharashtra
12.2019 - 02.2021
- Analyzing and sharing feedback on charts
- Identifying fatal errors and non‑ fatal errors impacting the process and take corrective/preventive action
- Monitor agents to identify errors, deviations & initiate corrective measures
- Provide actionable data to various internal support groups as needed
- Conduct feedback sessions with Agents
- Identify the gaps in current process & systems in order to improve overall quality of operations Participate in design of quality standards
- Prepare and analyze quality reports for management staff review.
Revenue Cycle Analyst
Inventurus Knowledge Solutions Private Limited
Mumbai, Maharashtra
11.2017 - 11.2019
- Review claim denials and payer requirements for corrective action and prevention in the future
- Review billing edits and provided insurance company with correct information
- Responsible for all follow upon insurance claims to Medicare, Medicaid and commercial insurance
- Understand insurance rules and regulations
- Processes payments from insurance companies Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations
- Submit claims and following up with insurance carriers on unpaid or rejected claims
- Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper CMS‑ 1500 form
- Follows up with insurance company on unpaid or rejected claims
- Resolves issue and re‑ submits claims
- Prepares patient statements for charges not covered by insurance
AR Specialist
Viaante Business Solution Pvt Ltd
Mumbai, Maharashtra
04.2017 - 10.2017
- Review claim denials and payer requirements for corrective action and prevention in the future.
- Review billing edits and provided insurance company with correct information
- Responsible for all follow upon insurance claims to Medicare, Medicaid and commercial insurance
- Understand insurance rules and regulations
- Processes payments from insurance companies Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations
- Submit claims and following up with insurance carriers on unpaid or rejected claims
- Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper CMS‑ 1500 form
- Follows up with insurance company on unpaid or rejected claims
- Resolves issue and re‑ submits claims
- Prepares patient statements for charges not covered by insurance
- Insures statements are mailed on a regular basis
- Prepares appeal letters to insurance carrier when not in agreement with claim denial
AR Associate
Gebbs Healthcare Solutions Pvt Ltd
Mumbai, Maharashtra
12.2015 - 01.2017
- Review claim denials and payer requirements for corrective action and prevention in the future
- Review billing edits and provided insurance company with correct information
- Responsible for all follow upon insurance claims to Medicare, Medicaid and commercial insurance
- Understand insurance rules and regulations
- Processes payments from insurance companies Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations
- Submit claims and following up with insurance carriers on unpaid or rejected claims
- Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper CMS‑ 1500 form
- Follows up with insurance company on unpaid or rejected claims
- Resolves issue and re‑ submits claims
- Prepares patient statements for charges not covered by insurance
Senior Customer Service Executive
First Source solution Ltd
06.2014 - 07.2015
- Manage and resolve customer query
- Answer calls professionally to provide information about products and services,take or obtain details of complaints
- Interact with customers by phone, e‑ mail concerning various issues
- Follow up to ensure that appropriate actions were taken on customers'requests
- Refer unresolved customer grievances or special requests to designated departments for further investigation
- Handle RI and NRI desk technical issue
- Take remote session for troubleshooting customer technical issue
- Make outcall to customer for welcome calling
Executive
Ashish chari & company
Mumbai, Maharashtra
01.2014 - 06.2014
- Managing the day‑ to‑ day operations of the office
- Organizing and maintaining files and records
- Planning and scheduling meetings and appointments
Office Assistant
Naresh munigall & Associates
04.2013 - 11.2013
- Managing the day‑ to‑ day operations of the office
- Organizing and maintaining files and records
- Planning and scheduling meetings and appointments
Executive
Sumit Services
Mumbai, Maharashtra
07.2012 - 04.2013
- Maintaining Diesel report tracker update in excel on Daily basis
- New Activities & plan operated in the excel sheets
- Tracking of OME & SME TTs (Corrective as well as Preventive Maintenance TTs) of Electrical Equipment like PIU, Power Plant, Diesel Generator & Battery bank
- Escalating &Tracking of TTs which violates SLA on daily basis
- To support BEAT plan activity & Tracking of BEAT plan compliance
- To handle the escalations on TOC applications received from OME, SME&Circle & to ensure end to end solution in liaison with TOC Network Support
- Tracking & Notification of all unplanned outages of TOC applications
- Escalation of Major Events of Circles at National Level
- Hierarchy
- Maintaining Daily outage Report of idea/Vodafone/airtel
Education
PGDM (HYBRID) in Healthcare Management
Welingkar Institute of Management
Mumbai 01.2021 - Current
Bachelor's Degree - Business Administration
Algappa University
01.2015 - 05.2018
HSC - HSC
Ramniranjan Jhunjhunwala
Mumbai 01.2006 - 02.2008
SSC -
Pune Vidya Bhawan
Mumbai 01.1996 - 03.2006
Skills
Strong leadership and mentoring skills
Able to juggle multiple responsibilities at one time
Excellent verbal and written English language communication skills
Strong knowledge of Health care vertical in RCM space
Target oriented and AR resolution mind set
Accomplishments
- Achieved Gebbs HIghFlyer Award in Gebbs Healthcare Solutions Pvt Ltd (2016‑ 07‑ 01)
- Achieved HighFlyers for Top Production & Quality in Gebbs Healthcare Solutions Pvt Ltd (2016‑ 12‑ 16)
- Achieved Awards for best employee of the year First Privilege Appreciation award for month of Oct‑ Nov‑ Dec 2014 in First Source Solutions Pvt Ltd (2014-12-14)
Software
ECW
Allscripts
ParallelClient
I-salus
Rehabilitation Tool
Timeline
Revenue Cycle Lead
Revupside Business Solutions Pvt Ltd
02.2021 - Current
PGDM (HYBRID) in Healthcare Management
Welingkar Institute of Management
01.2021 - Current
Quality Analyst
Viaante BusinessSolutions PvtLtd
12.2019 - 02.2021
Revenue Cycle Analyst
Inventurus Knowledge Solutions Private Limited
11.2017 - 11.2019
AR Specialist
Viaante Business Solution Pvt Ltd
04.2017 - 10.2017
AR Associate
Gebbs Healthcare Solutions Pvt Ltd
12.2015 - 01.2017
Bachelor's Degree - Business Administration
Algappa University
01.2015 - 05.2018
Senior Customer Service Executive
First Source solution Ltd
06.2014 - 07.2015
Executive
Ashish chari & company
01.2014 - 06.2014
Office Assistant
Naresh munigall & Associates
04.2013 - 11.2013
Executive
Sumit Services
07.2012 - 04.2013
HSC - HSC
Ramniranjan Jhunjhunwala
01.2006 - 02.2008
SSC -
Pune Vidya Bhawan
01.1996 - 03.2006