Sanjay Kumar N

As a Senior Lead I was responsible for RCS and COE team who specialists are acting as a liaison between client and internal operations team, the primary responsibility of the team is to reduce the practice KPI and Grades

• As chair of the SOP committee for our project, I was given the power to authorize SOPs and Companion Guides from the client and provide feedback and recommendations to prevent conflicts on updated from various documents and functions
• Played a key role in implementing AI assisted tool which help the production users make the right decisions by prompting the right questions which also provide a drafted comment as an output that helped improved the quality of handling a scenario and drafting notes
• Co-ordinate with client as a POC on a daily basis to manage backlogs, JIRA and other trends with Operations Managers from all functions
• Maintained attrition at Zero % for last 24 months by motivating the team and training my specialist to become a future leader
• I have trained and promoted 8 Specialist from my span to an operations Team Lead Level
• Implemented a specialty level structure within Revenue Cycle Specialist team wherein we have appointed Lead POC for each specialist and other RCS are tagged under them to encourage the Leadership quality as they tenure in this role
• Conduct various projects like ERA Enrollment, EDI enrollment, Portal, practice last touch to improve efficacy of the process
• Identifications of Collectible & Uncollectible from the 365+ claims
• Automation proposal on Authorization adjustment and small balance adjustment process
• Calibration connects for Managers, Team Leads and Process Coaches
• Creating question bank and Conducting calibration assessment for all the stakeholders on SOP and Companion guides which helps them to assist or train their respective production employees
• Implemented trend tracker based on payer vs carc code model
• Coordinate with Onshore Transition team on streamlining the new onboarding clients on initial setup of scrub rule, PWK and enrollments before the Go-live date ensuring smooth transition
• Coordinated with Onshore product team on resolving any software bugs and glitches identified at PM from all functions

As a Team Lead, I had the opportunity to manage two teams. One was the RCS team, where I worked as a specialist which now has 15 specialists, and the other was the Denials team, which comprised 22 denial users. It provided me with vast opportunities to analyze RCM from an eagle's eye perspective, allowing me to broaden my prospects at the analytics and automation levels.

• Cross utilized the team ability to find trends at denial level and implemented Scrub rules, PWK, etc
• Coordinated with RPA team on automating denials like CARC 109 and other eligibility denials
• Enhanced overall team performance by providing regular coaching, feedback, and production development strategies that helped the team to improve their past performances.
• Promoted a positive work environment by fostering teamwork, open communication, and employee recognition initiatives.
• I had developed a score card system for each practice and scored them depending on their KPIs and SLAs as A,B,C,D & F which were then recognized and implemented by our client at the Power BI dashboard.
• I have introduced the operations team on how to project DSO, 90+ and denial% for any issues found which later then was inducted as a regular practice at any report by the team
• Implemented practice bucket review report that helped our client identify which practice is delay in responding to our request which help us put an alarm system to get updates moved from practice end and also timely adjustment if needed
• Played a key role in managing the CHC (Change healthcare) issues with the client transition team and helped with our operations with projections on impact of this issue at each practice level (270+ practices)
• Prepare MBR and Client visit presentations for senior management
• Take part in offshore client visit presentations at board room on behalf of specialist team
• Hosted weekly meetings with the clients where the agenda would be AR Ageing review, 90+ days old issues, Industry KPI metrics etc.,
• Took full responsibility on handling Appraisal process for both production users and Specialist team

The role Revenue Cycle Specialist funwas established for the new project based on the client's request to partner or report directly with onshore Client Managers to handle end-to-end operations, prepare presentations, and address challenges for practices.

• Working with six US Client managers for 20 practices as a SPOC to the operations teams on updates and practice specifics.
• Collaborated with all departments across AR, Payments and Front End (Charges, Rejections, etc) for deep diving on issues for recommendation on process flow with client
• Performed On-boarding audits to new practice for our client on smooth transition of doctors with our client
• Connecting client thru our special chat access and also on calls for practice specific trends
• Provided training to the new staff on client specifics before making calls/actions in PM
• Sole responsible to update SOP/Practice Instruction sheets for clients on updates by practice
• Resolving all claims which has been ignored or left over for a longer period from specialist
• Review Rejection & AR trends to provide feedback to Client Managers/Revenue Cycle Advisor on onshore team to implement any Scrubs rules or PWK process through JIRA ticket process
• Research ERA's/EOB's from practice environment (PM, Practice Uploads, lock box and correspondence) to ensure it's posted within TAT
• Mid-month review on AR Last Touch report and identify claims needing follow up and report back to the AR team
• Duties to be assigned for teams on preparing the month end process reports
• We work on behalf of On shore clients at the project and address the client review accounts from payment, AR & Charges
• We are authorized to post payments when the teams are with insufficient information
• Responsible to work on CODING reviews claims and suggest a nominal codes to practice for approval as there was no specific coding process implemented for our project
• We also ensure the legacy payment are not missed by maintaining payment exception log
• Access to send On-demand patient statements from PM system
• Worked as a Admin to our project’s PM on adding payers based on Trizetto configuration and also had access to click level screen audit

As a Quality Analyst, we were deployed not only to conduct audits, but also to handle OJT and other trainings, as well as function as a senior mentor and backup to the Operations Lead.

• Participated and prepared agenda for the calibration and client calls
• Reported to the senior management in terms of process, audits and client reviews that includes Audit accuracy reports, Quality reports, TNI training, Feedback sessions and refresher training to bottom performers
• Developed formulated quality and production reports using 'sumif' formula
• Validated clients queries on a weekly basis
• Managed quality capacity planning and sampling plans.
• Supported Team Leader to achieve team performance
• Handled 3 projects simultaneously as a quality analyst.
• Experience on auditing multi specialty Physician billing and also worked on Pathology, DMEPOS (Prosthetics & Orthotics), Hospital, Underpayment recovery projects, etc
• Experience of creating SOP based on SOW signed with client and training documents for the team.
• Experienced in RCA which help build proactive CAPA to the team
• Daily huddles with the production team on client and quality updates
• OJT training to new team members, as the organization did not have process coaches during that period.

Initially, I worked as a production user at a multi-specialty client. Later, I was deployed at a emergency room client and became a mentor to the team due to the quality of notes and issue identification.

• Presented weekly updates to client on production and issues
• Worked a mentor to the team and provides process orientation to new joiners to the project
• Handling Provider critical escalation claims
• Denial Management
• Gained knowledge by assisting the Team Lead on preparing QBR and MBR decks