Prince J

Senior Analyst | R1RCM Global Pvt Lmt

Oct 2022 - Mar 2025 • 2 yrs 5 mos

Key Expertise: Led and mentored a team of medical billing and denial management analysts, ensuring high-quality claim resolution and productivity. Conducted onboarding and training sessions on medical billing concepts, insurance guidelines, claims processing, and denial resolution best practices. Managed Accounts Receivable (AR) follow-up for Medicare, Medicaid, and commercial insurance payers. Analyzed denial trends and implemented corrective actions to improve first-pass claim acceptance and reimbursement rates. Reviewed complex claim scenarios and provided guidance to team members for timely issue resolution. Monitored key performance indicators (KPIs), turnaround times (TAT), productivity, and quality metrics to ensure SLA compliance. Collaborated with cross-functional teams to resolve billing discrepancies and optimize revenue cycle performance. Prepared performance reports, delivered coaching sessions, and supported continuous process improvement initiatives. Key Achievements: Successfully led a high-performing team while consistently meeting productivity, quality, and client service targets. Improved claim resolution efficiency by identifying recurring denial patterns and implementing preventive strategies. Trained and mentored new hires, reducing onboarding time and helping them achieve performance goals more quickly. Enhanced team performance through regular feedback, quality audits, and one-on-one coaching sessions. Contributed to increased collections and reduced aging accounts by ensuring timely follow-up on denied and unpaid claims. Recognized for strong leadership, problem-solving, and the ability to manage complex revenue cycle challenges while maintaining high client satisfaction.

Senior AR Executive | Q Way Technologies Pvt Ltd

Jan 2019 - Oct 2022 • 3 yrs 9 mos

Key Expertise: Managed daily account allocations and prioritized claim follow-up based on aging reports, payer guidelines, and claim status. Performed comprehensive Accounts Receivable (AR) follow-up for Medicare, Medicaid, and commercial insurance claims. Investigated and resolved denied, rejected, and no-response claims through timely follow-up, appeals, and payer communication. Reviewed Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs) to identify payment discrepancies and denial reasons. Analyzed root causes of claim denials and implemented corrective actions to reduce recurring issues. Collaborated with internal teams to resolve billing, coding, and documentation-related claim issues. Maintained accurate account documentation and ensured all follow-up activities were completed within client turnaround time requirements. Assisted in training junior team members on medical billing processes, insurance guidelines, medical terminology, and compliance standards. Key Achievements: Successfully managed high-volume AR accounts while maintaining productivity, accuracy, and quality standards. Improved reimbursement outcomes by proactively resolving denied and aging claims through effective follow-up and appeals. Reduced outstanding receivables by prioritizing high-value and aged accounts for timely resolution. Contributed to improved team performance by mentoring junior analysts and sharing best practices for claim resolution. Maintained strong payer communication and consistently met client service level agreements (SLAs) and turnaround time (TAT) expectations. Recognized for analytical problem-solving, attention to detail, and the ability to resolve complex insurance claim issues efficiently.