SHREEJIT RAJAN
Navi Mumbai
Summary
Accomplished quality management professional with 10 years of experience specializing in U.S. Healthcare revenue cycle management . Currently serving as a Quality Manager, overseeing complex quality strategies in RCM and team performance to drive significant bottom-line results. Proven track record in implementing successful quality frameworks, and motivating high-performing teams.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Quality Manager
Inventurus Knowledge Solutions
Navi Mumbai
04.2025 - Current
- Strategizing and overseeing the end-to-end Quality Assurance framework for RCM operations.
- Leading a team of Quality Leads and Analysts to ensure compliance with client-specific SLAs, and industry standards.
- Analyzing high-level trends through Root Cause Analysis (RCA), and implementing corrective/preventive action plans.
- Driving process improvement initiatives to enhance accuracy in all functions such as AR, EVBV, Payment Posting, Charge Entry, Billing, and Credit Balance.
- Managing client interactions such as ATA ,Calibration call and reporting on Weekly and Monthly Business Reviews (WBR, MBR).
SME - QA
First Insight Software Solutions
10.2023 - 04.2025
- Allocating and managing work to team members according to the scope of work.
- Helping the team in handling and resolution of work-related problems, understanding and interpretation of issues, and decision-making.
- Ensure adequate onboarding and training for the team members to enhance capability and effectiveness.
- Interaction with the clients, taking feedback from clients and formulating strategies to meet the clients' specific needs and expectations.
- Performing ATA (Audit to Auditor) to ensure that the audits are being conducted as per plan.
- Getting involved in day-to-day calls and tracking closures for observations on quality.
- Identifying process gaps and offering solutions to address them.
Quality Analyst
First Insight Software Solutions
10.2020 - 09.2023
- Performing audits on AR and Eligibility Benefits Verification appointments specifically in Medical and ophthalmology.
- Identifying process gaps and do RCA providing feedback and coaching to associates.
- Publishing audit reports for the entire team on daily/weekly/monthly basis.
- Do Bottom Quartile Management and individual Pareto to ensure individual-level Performance improvement.
- Conduct weekly briefings with the team to share the areas of improvement.
- Worked on NextGen software and Change health (Emdeon) & Trizetto clearing house.
QUALITY ANALYST
Gebbs Healthcare Solutions
06.2019 - 10.2020
- Performing daily audits and sending daily audit report on daily basis with 48 hours TAT
- Call Monitoring and Providing feedback on the same Preparing Weekly and Monthly Dashboard
- Providing Effective & constructive feedback to the Associates to help in improving their performance
- Conducting Team briefing (QAT) sessions weekly
- Coordinating with Ops teams on process updates and any related information to be on the same page
- Attending client Calibration call Conducting PKT & Certification
- Publishing PPT WRR (Weekly Review Rhythm) & MRR (Monthly Review Rhythm).
SENIOR AR
Gebbs Healthcare solutions
08.2017 - 10.2020
- Worked as a senior AR in Hospital Billing for one year
- Doing Peer-to-Peer from the Insurances on behalf of the provider Worked on all AR denials
- Appeal and Insurance Contract follow up
- Taking eligibility & benefits of the patient from the insurance faxing clinicals to the insurance company for an approval.
- Working on response received from coder .
- Worked as NDQA for 6 months.
ACCOUNT RECEIVABLE
IKS
06.2016 - 07.2017
- Worked in Multi-specialty Physician billing as an Account Receivable.
- Worked on all type of denied claims.
- Sending a corrected claim via mail or fax for required claims.
- Forwarding appeals with required documents to the insurance via mail and fax for the denied claims.
- Worked on all Commercial and Federal payers.
Education
B. A -
Mumbai University
01.2015
H.S.C -
Maharashtra State Board
01.2012
S.S.C -
Maharashtra State Board
03-2010
Skills
- Good researcher, methodical, probing and resourceful
- High integrity and honesty, ethical, and socially aware
- Quality improvement and audit processes
- Bottom quartile management
- Team leadership
- Quality assurance root cause analysis problem solving
- Stakeholder communication
- Decision making
- Continuous improvement
- Control plan development
- Statistical analysis skills
- Risk management
- Client relationship management
Certification
Certified Lean Six Sigma Green Belt with experience in streamlining processes and reducing defects. Improved the performance of the BQ associates by 6% through targeted RCA and coaching. Utilized client feedback to formulate strategies that reduced recurring billing errors. Reduced AR denials and external tasking by implementing strategies on internal projects.
Timeline
Quality Manager
Inventurus Knowledge Solutions
04.2025 - Current
SME - QA
First Insight Software Solutions
10.2023 - 04.2025
Quality Analyst
First Insight Software Solutions
10.2020 - 09.2023
QUALITY ANALYST
Gebbs Healthcare Solutions
06.2019 - 10.2020
SENIOR AR
Gebbs Healthcare solutions
08.2017 - 10.2020
ACCOUNT RECEIVABLE
IKS
06.2016 - 07.2017
B. A -
Mumbai University
H.S.C -
Maharashtra State Board
S.S.C -
Maharashtra State Board