Swapnarun Dalai

Roles & Responsibilities:

• Team Leadership and Supervision:

Manage and supervise a team of medical billing specialists.

Provide training and development opportunities for team members.

Monitor team performance and conduct regular performance reviews.

• Billing Process Management:

Oversee the entire medical billing process to ensure accuracy and efficiency.

Ensure timely submission of medical claims to insurance companies.

Handle complex billing issues and resolve discrepancies.

• Compliance and Regulations:

Ensure all billing practices comply with federal and state regulations.

Stay updated on changes in healthcare laws and insurance policies.

Implement and maintain compliance programs and policies.

• Reporting and Analysis:

Prepare and analyze billing reports to identify trends and areas for improvement.

Generate financial and operational reports for upper management.

Use data to forecast future billing trends and staffing needs.

• Customer Service and Communication:

Act as a point of contact for clients and address their billing concerns.

Communicate effectively with insurance companies, healthcare providers, and patients.

Resolve customer complaints and disputes in a professional manner.

• Quality Assurance:

Implement quality control measures to ensure accuracy in billing and coding.

Conduct regular audits of billing processes and records.

Develop and enforce standard operating procedures.

• Technology and Software Management:

Ensure the medical billing software is used effectively and efficiently.

Stay updated on new software and technology advancements in the industry.

Train staff on new systems and software updates.

• Financial Management:

Monitor accounts receivable and ensure timely collection of payments.

Work with the finance department to manage budgets and financial planning.

Analyze financial data to optimize billing processes and revenue cycles.

• Problem-Solving and Decision-Making:

Address operational challenges and implement solutions.

Make informed decisions to improve billing processes and team performance.

Handle escalated issues and provide guidance to team members.

• Strategic Planning and Development:

Assist in developing and implementing strategic plans for the billing department.

Collaborate with senior management to set goals and objectives.

Identify opportunities for growth and improvement within the department.

🔹 Key Expertise:

• Revenue Cycle Management
• Denials Management
• Healthcare Compliance
• Team Leadership
• Process Improvement
• Client Relationship Management

🔹 Professional Highlights:

• Successfully led a team of over 50 medical billers to consistently exceed monthly revenue targets, resulting increase in collections.
• Implemented streamlined billing procedures that reduced claim processing time and increased first-pass claim acceptance rates.
• Played a pivotal role in ensuring compliance with HIPAA regulations, maintaining a zero-violation record during audits.
• Collaborated with cross-functional teams to develop and execute training programs that enhanced employees' coding accuracy and efficiency.
• Conducted regular performance evaluations, provided constructive feedback, and mentored team members to foster their professional growth.

• Ensure optimum Quality from my team members
• Audit, Feedback, Briefing, Coaching session, monitoring, guiding & motivating my team members to meet Quality
• Conducting monthly reviews with my team members & identify opportunity areas in terms of core process matrix and client requirements
• Maintaining Quality performance, unique call percentage, ICF percentage
• Publishing TCD compliance, Network call handling and Data not working related call handling reports on daily, weekly & monthly basis
• Conducting pre & post shift briefing and dissemination of updates
• Floor monitoring Provide advice & assistance to my team leader in implementation of evaluation/in the existing system
• Organizing team meetings to update the associates on any product and process changes.

• I joined Aditya Birla Minacs as a Customer Service Associate Operations & promoted as Senior Executive Operations to take !-Assist (Escalation) calls after one year and then promoted as VAS SME to take waiver refund related calls
• As a Senior Executive I was responsible for handling Escalation calls
• Floor monitoring
• Giving updates in the floor.