Shubham Awasthi

I have been working as an Analyst in Financial Clearing Centre (FCC) in Healthcare Revenue Cycle Management with R1 RCM (IMH,Tulsa & Pennsylvania Healthcare), Gurgaon from September 2020.

• Verification of Coverage (SLA day 1-10) , Claims Adjudication needs to update the eligibility date and benefits (deductible, out of pocket, Co pay, co insurance,) as per the plan/payer using the provided payers websites or by calling on providers line,
• FCC applies the principles of strong people, excellent processes, and effective technology to provide excellent customer service and better patient outcomes,
• Interact with US Insurance Clients,
• Results-focused to ensure consistent team performance within SLA,
• Generated ad-hoc reports to evaluate specific business requirements.
• Updating the DRG, DX, CPT, HCPCS codes in the R1RCM tools using the provided providers websites and tools,
• Maintain the patients accounts that includes inpatient, outpatient, observations stay and surgery patients, of the facility Providence hospital,
• Communication with support Team and implement the organization's operation policies,
• Working in multiple buckets to process the accounts to achieve the daily, weekly and monthly targets,
• Working of service and Authorization, Service Entry, Pre-Reg and shelling (Live Process),
• Work on Different R1 Websites Like UHC, Humana, Medicaid, Availity, Cigna, Noridian, Select Health ,BCBS , Veteran, Humana, UMR, OPTUM, Medicaid, Aetna, EMI, Evicore , Athena etc,
• Complete the Coverage, benefits and Authorization and update the facility host and R1RCM hub,
• Providing Trainings to New hire Employees in process,
• High quality delivery is required that is 98%,
• High targets are required to be achieved,

• I have worked in medical billing where we have to bill hospital claims to insurance for Medicare Part D drug coverages. An Express Scripts Holding Company is a pharmacy benefit management (PBM)
• organization. The company processes pharmaceuticals claim for US citizens through a network of retails pharmacies. We dispense medications for chronic long-term diseases, such as diabetes, cancer, or heart disease, directly to members by home delivery.
• Worked on tool named as PEGA and RX HOME.
• Process invoices as per client requirements.
• I update all the boxes in claim form. We work on Hospital billing.
• We bill inpatient and outpatient both claims.
• I was working in a pilot queue batch for high dollar billing claims.
• Create Medical record number (MRN) which is very important to raise claim.
• Providing Supportive documentations for Audits.
• Preparing Daily, Weekly and Monthly Accounts Receivable reports for receivable accounts asper defined SLA by client.
• Manage Sales order management Queue for life saving drugs.
• Apply the payment against of open invoices and Identify the unapplied invoices.
• Managing SOP's (Standard Operating Procedure) of all process activity
• Engaged with customers to build business relationships.
• Developed and updated policies and procedures, maintaining compliance with statutory, regulatory and local, state and federal guidelines relating to HIPAA, benefits administration and
• general liability.

Completed a project on Order to Cash Process
• Order Processing
• Invoicing Processing
• Good and Service Tax (GST)
• Sales Order Processing in S.A.P
• Maintaining the Calendar of the Company
• Creating the invoices as per the Purchase Order/ Sales Order