Suraj Shaw
US Healthcare RCM
Ahmedabad,GJ
Summary
With 9+ years of experience in U.S. healthcare RCM, I specialize in medical, dental, and DME billing, as well as IV, AR, and claims/denial management. I excel in optimizing cash flow, resolving denials, and ensuring compliance with payer guidelines, improving financial outcomes and operational efficiency for healthcare organizations.
Overview
11
11
years of professional experience
1
1
Certification
Work History
BUSINESS DEVELOPMENT EXECUTIVE
Nurturemind Tech Services Pvt. Ltd.
01.2024 - 12.2024
- Experienced Global Business Development Professional specializing in new IT solutions, including Healthcare Sector, Blockchain, AI, AR/VR, Beacon, Fintech and IoT for Enterprise Apps
- Proven track record in new business acquisition, account management, and strategic partner/alliance development
- Expert in Sales Navigator lead management, LinkedIn profile management, Ghostwriting, conversion, and cross-selling/up-selling initiatives
- Skilled in presenting compelling value propositions and success stories to prospects
- Committed to client satisfaction through proactive sales, meticulous record-keeping, and customer-centric follow-ups
- Adept at building and executing multi-channel Go-To-Market strategies
SR. REVENUE CYCLE SPECIALIST
Sixapart Healthcare Pvt. Ltd.
10.2023 - 01.2024
- Accomplished professional specializing in orders supply chain management and prior authorization for DME (Durable Medical Equipment) in the US Healthcare sector
- Proven expertise in optimizing supply chain processes, ensuring efficient order fulfillment, and navigating complex regulatory requirements to secure timely authorizations
- Skilled in vendor relations, contract negotiation, and inventory management to meet the dynamic demands of healthcare
- Committed to driving operational excellence and enhancing patient care through streamlined supply chain management
SR. PROCESS ASSOCIATE
Shivohm Softech Pvt. Ltd.
06.2022 - 10.2023
- Contact with insurance carriers to discuss policies and individual patient benefits Reviewed, verified insurance coverage
- Collaborated with staff members to enhance and exceed team goals through effective client satisfaction rates
- Increased efficiency and team productivity by promoting operational best practices
- Correction and resubmission of the rejected claims with appropriate details
- Follow up on the Insurance Aging Report and checking claim status to get the maximum revenue and to avoid timely filing
- Dentrix Software experience and different tools, managing patient appointments, patient charts, demography's and in house clearing house i.e
- Dentemax and Remote Lite
SR. CLIENT SERVICE EXECUTIVE
Analytix Solutions Pvt. Ltd.
04.2021 - 06.2022
- Durable Medical Equipment Processing
- Calls to HMO, PPO, Medicare Insurance Companies for Eligibility and Benefits on behalf of Doctor
- Home Medical Equipment Processing, Sending Consent Form and Medical records
- Fixing Appointment Slots for Physician in Appointment 360
- Calls for taking claim status and posting the EOBs
- Participated in cross-functional teams to improve processes and procedures related to client service delivery
- Trained junior team members on best practices for delivering exceptional customer service experiences
CLAIMS SPECIALIST
Sita Revenue Cycle Management Pvt. Ltd.
08.2020 - 03.2021
- Gained expertise in all aspects of medical billing including filing claims, refund requests, re-filing rejected claims, completing appeals, and adjusting underpayments
- Calls to HMO, PPO, Medicare Insurance Companies for Claim Status, Claims Followup on behalf of Doctor
- Researched medical records to evaluate claim validity and verify the existence of pre-existing conditions
- Processed payments for valid claims according to established procedures
- Solved Denial and Rejected Claims and get it Reprocess
- Sending Medical records and Appeals
QA AND REIMBURSEMENT SPECIALIST
Sita Revenue Cycle Management Pvt. Ltd.
03.2016 - 07.2020
- Spearheaded quality control of data entry system holding patient registration, diagnoses, and insurance card information
- Acted as a liaison between the business department, billing, and medical records to resolve billing errors and apply appropriate ICD 10, CPT and HCPCS codes, charges, and corrected charges
- Partnered with the business department, billing, and third party payers to ensure accurate billing, reimbursement, and filing of denied claims
- Reviewed remittance codes from EOBs/ARs, and posted charges, payments, and adjustments
- Stayed current with changes in HCPCs, CPTs, DRG, and reimbursement for Medicare and Medicaid for the Chargemaster
- Kept accurate log of all requests for medical information and records
PATIENT REPRESENTATIVE
Sita Revenue Cycle Management Pvt. Ltd.
07.2013 - 02.2016
- Advocated for patients by contacting insurance companies to ensure timely payments and resolve errors on rejected claims
- Diligently prepared all required claims documentation including referrals, treatment plans, or other required correspondence to reduce incidence of denials
- Reviewed outpatient records and interpreted documentation to identify all diagnoses and procedures
- Analyzed medical records to satisfy insurance company mandates
- Followed up on legal claims
- Researched and followed up on denied insurance claims
- Reviewed outgoing bills for eligibility and accurateness
Education
M.sc - Forensic Science
DEPARTMENT OF FORENSIC SCIENCE, GUJARAT UNIVERSITY
01.2015
B.sc - Chemistry
CU SHAH SCIENCE COLLEGE, GUJARAT UNIVERSITY
01.2013
Skills
- Revenue Cycle Management
- HME/DME Processing
- eClinicalWorks
- PowerSoft
- Office Ally
- CGM software
- HIVE
- Brightree
- Dentrix software
- Knowledge of HMOs/PPOs
- Medicare
- Medicaid
- Data Analysis
- R&D
- Patient Accounts
- Claims Reconciliation
- ICD 10 Billing
- CPT/HCPCs
- CDT Codes knowledge
- A/R expertise
- EV & IV expertise
- Insurance Contracts
- Appeals
- EOBs
- CareTend
- S3
- Linkedin Profile Management
- Sales Navigator
- Ghostwriting
- Meeting Scheduling
- Lead Generation
- Strategy Maker
- Client Confidentiality
- AI Tech
- Tool user
- Web surfer
- Process Analysis
- Tracking Trends
Certification
- Completed Professional Chess Coach Course from Swarnim Gujarat Sports University.
- Completed a basic course in Rifle Shooting conducted by the Ahmedabad Military and Rifle Training Association.
- Completed one month internship in CBI/CFSL New Delhi in Document Division.
- Completed 0.22 Rifle Shooting training from Rifle Club.
Activities
- Passionate Chess Player
- Freelance Chess Coaching
Languages
Bengali
Bilingual or Proficient (C2)
English
Bilingual or Proficient (C2)
Hindi
Bilingual or Proficient (C2)
Gujarati
Bilingual or Proficient (C2)
Timeline
BUSINESS DEVELOPMENT EXECUTIVE
Nurturemind Tech Services Pvt. Ltd.
01.2024 - 12.2024
SR. REVENUE CYCLE SPECIALIST
Sixapart Healthcare Pvt. Ltd.
10.2023 - 01.2024
SR. PROCESS ASSOCIATE
Shivohm Softech Pvt. Ltd.
06.2022 - 10.2023
SR. CLIENT SERVICE EXECUTIVE
Analytix Solutions Pvt. Ltd.
04.2021 - 06.2022
CLAIMS SPECIALIST
Sita Revenue Cycle Management Pvt. Ltd.
08.2020 - 03.2021
QA AND REIMBURSEMENT SPECIALIST
Sita Revenue Cycle Management Pvt. Ltd.
03.2016 - 07.2020
PATIENT REPRESENTATIVE
Sita Revenue Cycle Management Pvt. Ltd.
07.2013 - 02.2016
B.sc - Chemistry
CU SHAH SCIENCE COLLEGE, GUJARAT UNIVERSITY
M.sc - Forensic Science
DEPARTMENT OF FORENSIC SCIENCE, GUJARAT UNIVERSITY
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