Sanjay Yadav
Ghaziabad
Summary
Detail-oriented Quality Auditor with 7+ years of experience in U.S. Healthcare RCM, specializing in Eligibility & Benefits Verification (E&B), Accounts Receivable, Payment Posting, Claims Processing, Denial Management, and Prior Authorization. Proven ability to audit end-to-end RCM workflows, identify accuracy gaps, strengthen process compliance, and improve overall operational quality.
Expert in conducting eligibility audits across payer portals, interpreting benefits, verifying coverage details, validating demographic accuracy, and ensuring compliance for clean claim submission. Strong track record in RCA, client collaboration, team training, and performance improvement aligned with HIPAA standards.
Overview
7
7
years of professional experience
Work History
QA (Quality analyst)
CGM ARIA (MDEVERYWHERE India Pvt Ltd)
Noida
12.2022 - Current
- Conduct detailed audits of accounts receivable, eligibility verification, and payment postings, insurance & eligibility verification, claim submission, charge and demo entry to ensure accuracy and compliance.
- Collaborate with client representatives to resolve queries and enhance service delivery.
- Develop and implement training modules to improve team productivity and quality standards.
- Lead root cause analysis sessions to identify process gaps and implement corrective actions.
- Ensure strict adherence to HIPAA and other regulatory compliance standards.
- Provide regular performance reports and quality updates to management and stakeholders.
- Implemented automated testing procedures to enhance accuracy and efficiency of QA processes.
- Proficient in using various payer portals to validate insurance benefits, coverage status, and eligibility information.
- Maintained and monitored aging reports to optimize revenue and financial performance for clients.
Quality Analyst
First Insight Inc.
Pune
03.2021 - 11.2022
- Learned in-depth about Ophthalmology services, working closely with clients to achieve their objectives.
- Worked as a Quality Analyst and conducted in-depth audits of prior authorization processes to ensure authorizations were obtained accurately based on the services rendered and patient plan requirements. Reviewed authorization requests submitted by associates as well as insurance call interactions to verify that all necessary clinical and demographic information was correctly validated, documented, and submitted.
- Worked closely with U.S. clients to optimize revenue cycle workflows and meet client KPIs.
- Improved team productivity through continuous feedback, coaching, and performance monitoring.
- Helped reduce AR backlogs and increased collections through targeted quality interventions.
Account Receivable Associate
First Insight Inc.
Pune
02.2020 - 03.2021
- Managed end-to-end AR follow-up, ensuring timely resolution of outstanding claims and reducing aging.
- Performed denial analysis and implemented corrective steps to improve claim acceptance rates.
- Contacted payers via calls and portals for claim status, eligibility, and required documentation.
- Corrected and resubmitted denied or returned claims with updated information.
- Worked across Medicare, Medicaid, and commercial insurance carriers for claim adjudication.
- Reduced AR aging by prioritizing high-dollar and high-impact claims.
- Maintained detailed account documentation in billing software for audit and compliance.
- Coordinated with coding, charge posting, and E&B teams to address claim discrepancies.
- Ensured compliance with HIPAA and payer-specific policies.
AR (Account Receivable) U.S. Healthcare (Revenue Cycle Management)
Mmodal (Aquity) Global Services
Pune
06.2018 - 09.2019
- Managed end-to-end AR follow-up, ensuring timely resolution of outstanding claims and reducing aging.
- Performed denial analysis and implemented corrective steps to improve claim acceptance rates.
- Contacted payers via calls and portals for claim status, eligibility, and required documentation.
- Corrected and resubmitted denied or returned claims with updated information.
- Worked across Medicare, Medicaid, and commercial insurance carriers for claim adjudication.
- Reduced AR aging by prioritizing high-dollar and high-impact claims.
- Maintained detailed account documentation in billing software for audit and compliance.
- Coordinated with coding, charge posting, and E&B teams to address claim discrepancies.
- Ensured compliance with HIPAA and payer-specific policies.
Education
B. Com -
Senior Secondary -
STATE Board
Higher Secondary -
CBSE Board
Skills
Eligibility & Benefits Verification Auditing
Patient Demographics & Insurance Validation
Prior Authorization
Claim Submission & Denial Resolution
Accounts Receivable & Aging Management
Payment Posting Audit
RCM Quality Assurance & Workflow Optimization
Root Cause Analysis
Process Improvement & Compliance
Client Communication & Reporting
Training & Performance Coaching
HIPAA Regulatory Standards
Performance Reporting
Revenue Optimization
Process Documentation
Client Management
Leadership & Team Coordination
Hobbies and Interests
- Playing and Watching Cricket
- Watching Movies
- Bike rides
Languages
- English
- Hindi
Personal Information
- Date of Birth: 05/28/93
- Gender: Male
Languages
Hindi
First Language
English
Advanced
C1
Timeline
QA (Quality analyst)
CGM ARIA (MDEVERYWHERE India Pvt Ltd)
12.2022 - Current
Quality Analyst
First Insight Inc.
03.2021 - 11.2022
Account Receivable Associate
First Insight Inc.
02.2020 - 03.2021
AR (Account Receivable) U.S. Healthcare (Revenue Cycle Management)
Mmodal (Aquity) Global Services
06.2018 - 09.2019
B. Com -
Senior Secondary -
STATE Board
Higher Secondary -
CBSE Board