Mohammed Siddiqui
Aurora,IL
Summary
Revenue Integrity Specialist with a coding background (CPT/HCPCS, ICD-10) and hands-on charge description master (CDM) oversight. Experienced in conducting charge capture audits, reviewing patient records, EOBs/ERAs, and financial statements to identify coding, pricing, and capture discrepancies and develop action plans. Advanced Excel (VLOOKUP, pivot tables), Power BI (DAX) and Epic experience; proven ability to manage high-volume denial worklists and produce audit-ready reports that maximize reimbursement and ensure compliance.
Revenue Cycle Specialist with strong expertise in analyzing financial data and improving billing and collection processes. Known for fostering team collaboration and driving results, adaptable to changing needs, ensuring seamless coordination. Skillset includes revenue cycle management, financial reporting, data analysis, and process optimization, combined with proactive and reliable approach to achieving organizational goals.
Overview
7
7
years of professional experience
Work History
Revenue Cycle Analyst
Omega Healthcare
Remote
01.2022 - Current
- Oversee maintenance of the charge description master (CDM), reviewing and approving all new charge builds
- Extract, analyze, and interpret large denial datasets using Power BI and Advanced Excel (VLOOKUP, pivot tables) to identify payer trends, high-impact denial categories, and operational bottlenecks across the revenue cycle.
- Investigate denial facts by reviewing claim history, EOB/ERA details, clinical documentation, coding accuracy (CPT/HCPCS, ICD-10), and authorization records to determine root cause.
- Develop advanced DAX calculations to measure first-pass denial rate, avoidable vs. unavoidable denials, recovery
- Research Medicare, Medicaid, and Commercial payer policies to validate medical necessity, coverage guidelines, timely filing limits, and reimbursement rules.
- Review and validate CPT units before submission to ensure alignment with CMS Medically Unlikely Edit (MUE) thresholds, preventing automatic payer denials.
- Lead detailed RCA investigations for recurring denial types such as authorization, medical necessity, coding accuracy, COB conflicts, and timely filing rejections.
- Conduct charge capture audits by reviewing patient records, billing data, and financial statements to identify charge, coding, or pricing discrepancies and develop action plans for remediation.
- Translate complex denial findings into actionable corrective actions and process changes, improving claim quality and reducing denial recurrence.
- Prepare, submit, and support appeals by compiling required documentation, coding validation, and regulatory justification to maximize overturn success.
- Apply provider contract terms and fee schedules to validate reimbursement accuracy and identify underpayments based on negotiated rates.
- Track denial trends, appeal outcomes, and recovery rates; produce audit-ready summaries and recommendations for clinical and finance teams.
- Build appeals reporting and dashboards that highlight root causes, overturn trends, and operational opportunities for improvement.
- Investigated claims to ensure compliance with payer policies and state/federal billing regulations; contacted payers to follow up on pending appeals, document status updates, and escalate unresolved claims.
- Independently manage assigned denial worklist of 40–60 accounts daily while meeting established productivity and quality benchmarks.
- Applied HIM principles to optimize revenue capture and minimize claim denials.
- Remote
- Analyzed revenue cycle processes to identify inefficiencies and recommend improvements.
Billing Specialist
Fortis Healthcare
Hyderabad, TS
01.2019 - 01.2021
- Reviewed and reconciled ERA, EOBs, checks, and credit card payments, posting payments with 99% accuracy to minimize downstream errors.
- Researched and resolved payment discrepancies, underpayments, and payer rejections to ensure compliance
- Processed refunds and adjustments for overpayments in alignment with company policy and payer guidelines.
- Communicated with insurance carriers, payers, and patients to resolve posting and balance issues efficiently.
- Monitored unapplied cash balances and collaborated with AR teams to ensure timely allocation and resolution.
- Ensured compliance with HIPAA and payer-specific regulations in all payment posting and reconciliation activities.
- Generated reconciliation and financial reports to support revenue integrity and monthly audits.
- Utilized knowledge of ICD-10-CM and CPT/HCPCS coding when reviewing EOBs and ERA files to ensure accuracy of posted charges and adjustments.
- Contributed to AR reduction initiatives by providing accurate payment data and collaborating with denial
- Process IP, OP, Day Care, Emergency, and Cashless billing as per the hospital tariff master and TPA-approved
- Submit claim documents to insurers/TPAs via portals (MediAssist, FHPL, Vidal, Paramount, MD India, Star) within
- Applied utilization management principles to optimize billing and coding accuracy, directly impacting revenue integrity
- Implemented CPC controls to safeguard revenue integrity and compliance as a revenue integrity analyst
- Analyzed billing data trends to identify areas for improvement in revenue cycle management.
Education
Master of Science (M.S.) - Information Technology & Management
Campbellsville University
Campbellsville, KY05-2026
Bachelor of Engineering (B.E.) - Computer Science
Osmania University
05-2026
Skills
- Denial analytics
- Billing Management
- Revenue Integrity & Compliance
- Technical Skills
- HIPAA regulations
- Charge Description Master (CDM) maintenance
- Revenue Code & Pricing Compliance
- Payer policy interpretation (Medicare/Medicaid/Commercial)
- CPT/HCPCS & ICD-10 compliance
- Documentation alignment for medical necessity
- Preventable vs non-preventable denial identification
- Root-cause analysis (RCA)
- Denied claim follow-up
- Appeals support
- AR denial management
- Power BI
- SQL
- Advanced Excel (VLOOKUP, INDEX/MATCH, Pivot Tables, Power Query)
- Clearinghouse tools
- Epic HB workflows
Languages
Arabic
Elementary
English
Full Professional
Hindi
Native or Bilingual
Timeline
Revenue Cycle Analyst
Omega Healthcare
01.2022 - Current
Billing Specialist
Fortis Healthcare
01.2019 - 01.2021
Master of Science (M.S.) - Information Technology & Management
Campbellsville University
Bachelor of Engineering (B.E.) - Computer Science
Osmania University