Vishal Tiwari

• Hands-on experience in US Healthcare Revenue Cycle Management (RCM) with expertise in AR Follow-up, claim processing, and denial management.

• Worked on Medicare, Medicaid, HMO, PPO, POS, and Commercial insurance claims to ensure timely reimbursement.

• Experienced in Prior Authorization and Pre-Authorization processes, including authorization verification, follow-up, and denial resolution.

• Utilized EPIC and Availity Portal for eligibility verification, benefits review, claim status checks, and authorization tracking.

• Performed denial analysis, appeals, and account follow-up to maximize revenue recovery and reduce AR aging.

• Maintained patient account records through calls, fax, and email while ensuring HIPAA compliance.

• Collaborated with insurance companies, providers, and internal teams to resolve claim and payment issues efficiently.

• Strong skills in problem-solving, customer service, dispute resolution, and payer communication.

• Processed medical and hospital claims under the ECHS program.

• Provided benefit, coverage, and claim status information to clients.

• Calculated patient responsibility, including Copay, Coinsurance, Deductible, and Out-of-Pocket amounts using Stop Loss Calculator and plan benefits.

• Resolved claim and payment-related inquiries from clients.

• Performed payment posting and ensured accurate processing of payments, worked on multiple rumba screens.

• Maintained accurate documentation while adhering to healthcare compliance guidelines.