Radhakrishna Goud
Maryville,USA
Summary
Experienced healthcare and IT professional with over four years of expertise in revenue cycle management, including AR/AP, payment posting, and claims processing. Skilled in reducing denial rates through analysis and corrective actions. Proven ability to train and lead teams as a Process Coach, and ensure compliance as a Quality Analyst. Strong technical background, with hands-on experience in tools like Splunk, Selenium, and SQL. Adept at supporting healthcare IT systems to streamline operations and improve service delivery. Known for attention to detail, strong communication, and a commitment to continuous improvement.
Overview
5
5
years of professional experience
Work History
Quality Analyst
AGS Healthcare
11.2021 - 07.2023
- Monitored and evaluated operational workflows to ensure compliance with quality standards and healthcare billing regulations
- Conducted root cause analysis on claim denials and identified patterns to implement corrective actions
- Collaborated with cross-functional teams to address quality issues and enhance service delivery
- Prepared detailed reports on performance metrics and provided actionable recommendations to leadership
- Conducted regular audits of accounts to ensure accuracy in payment posting and claim submissions
- Completed GA audits for RCM processes by strictly following the QIP guidelines, ensuring accurate and compliant workflows
- Provided feedback to team members on errors identified during audits, guiding them on improvements and best practices for compliance
- Escalated any anomalies, trends, or compliance issues promptly to management for further review and resolution
- Performed actual production work to stay updated with the latest industry practices, regulatory changes, and real-time scenarios
- Participated in critical audits, closely monitoring trends and coding compliance to ensure all processes adhered to the necessary guidelines
- Reported findings from audits, highlighting areas for improvement and ensuring corrective actions were taken in a timely manner
- Collaborated with cross-functional teams to address quality issues and improve overall performance in RCM processes
- Assisted in developing and refining audit procedures to ensure continuous improvement in the quality of RCM services
- Analyzed audit data to identify recurring issues, proposing solutions to reduce errors and improve efficiency in operations
- Conducted regular audits of coding accuracy and billing practices to ensure adherence to industry standards and payer requirements
- Monitored and analyzed key performance indicators (KPIs) related to coding accuracy, claim rejections, and payment delays to identify areas for improvement
- Facilitated training sessions for team members on quality standards, coding updates, and compliance to ensure consistent performance and accuracy
- Conducted root cause analysis for recurring issues in the revenue cycle, proposing corrective actions to address inefficiencies and improve overall workflow
- Ensured the accuracy of patient data and medical coding through periodic reviews and audits, minimizing errors that could impact reimbursement
- Collaborated with the compliance team to ensure adherence to regulatory standards, such as HIPAA and payer-specific guidelines, throughout the RCM process
Process Coach
PrimEra Medical Technologies
01.2021 - 11.2021
- Conducted comprehensive training programs for new hires, covering healthcare billing processes, payment posting, and claim management
- Monitored team performance and provided feedback to improve productivity and adherence to quality standards
- Reviewed and analyzed accounts to ensure compliance with organizational and regulatory requirements
- Developed training materials and standard operating procedures to streamline onboarding and skill enhancement
- Evaluated claim denial patterns and collaborated with the team to refine appeal strategies, resulting in a 16% improvement in claim resolution
- Provided coaching and guidance to team members on RCM healthcare processes, ensuring adherence to industry standards and best practices
- Monitored team performance, identifying areas for improvement and offering solutions to enhance productivity and accuracy
- Conducted regular training sessions to keep the team updated on the latest healthcare regulations, coding updates, and payer policies
- Provided real-time support to team members, addressing questions and resolving issues to maintain smooth operations
- Reviewed key performance indicators (KPIs) with the team, offering constructive feedback and strategies for improving metrics such as DSO and claim rejection rates
- Developed and implemented performance improvement plans for team members, focusing on specific areas like coding accuracy and payment collection
- Collaborated with management to align team goals with organizational objectives, ensuring the team contributed effectively to overall revenue cycle performance
- Observed and analyzed team workflows, identifying inefficiencies and recommending process changes to optimize performance
- Coached team members on compliance standards, ensuring that all processes adhered to regulatory requirements such as HIPAA and payer-specific rules
- Monitored and provided feedback on quality audits, helping team members address errors and improve the quality of their work
- Facilitated problem-solving sessions to address challenges in revenue cycle management, guiding the team in troubleshooting issues and implementing solutions
- Tracked team progress and individual development, offering continuous feedback to encourage professional growth and improvement
- Managed the implementation of new processes or system updates, ensuring smooth transitions and proper training for the team
- Motivated and engaged team members, fostering a positive work environment and encouraging a proactive approach to challenges
- Led team meetings to discuss updates, trends, and any issues that needed attention, ensuring everyone was aligned on priorities and goals
Accounts Receivable Specialist
R1 RCM
08.2019 - 01.2021
- Managed accounts receivable processes, including invoicing, payment collection, and account reconciliation
- Posted payments accurately into the system, maintaining up-to-date account records
- Resolved discrepancies in accounts by investigating and addressing underlying issues
- Identified claim denials, prepared appeals, and ensured timely resubmissions to minimize revenue loss
- Communicated with insurance providers to address claim issues and expedite payment processing
- Submitted insurance claims accurately and on time, ensuring all patient and insurance details were verified to avoid rejections or delays
- Actively followed up on outstanding claims, investigating and resolving any denials by correcting errors and appealing when necessary
- Posted payments from both insurance companies and patients, ensuring they were recorded accurately and reconciled with corresponding claims
- Managed aged accounts by regularly following up on outstanding balances and setting up payment plans to reduce Days Sales Outstanding (DSO)
- Conducted insurance verifications before services were provided, confirming coverage and ensuring pre-authorization requirements were met
- Generated and sent patient bills, addressed inquiries, and provided assistance in understanding charges, insurance benefits, and payment options
- Ensured that medical coding (ICD, CPT, HCPCS) was accurate and in compliance with payer guidelines, staying updated on changes and new requirements
- Prepared regular accounts receivable aging reports, analyzed performance metrics, and provided management with insights to improve the revenue cycle
- Ensured that all billing practices adhered to HIPAA and payer-specific policies, staying informed about regulatory changes affecting the revenue cycle
- Investigated payment disputes and worked with insurance companies to resolve underpayments or overpayments, making necessary corrections to patient accounts
Accounts Payable Specialist
Sutherland Global Services
08.2018 - 08.2019
- Processed vendor invoices, ensuring accuracy and timely payment
- Maintained documentation for all payable transactions, ensuring audit compliance
- Reconciled account balances and resolved payment discrepancies in coordination with vendors
- Supported month-end and year-end closing activities by preparing accurate financial reports
- Managed the processing of invoices and ensured accurate and timely payments to vendors and healthcare providers
- Verified and reviewed purchase orders, contracts, and receipts to ensure proper documentation and compliance with payment terms
- Ensured all vendor payments were processed in accordance with contractual agreements, ensuring compliance with healthcare industry standards
- Coordinated with vendors and internal departments to resolve any discrepancies or issues related to invoices, payments, or contracts
- Monitored accounts payable aging reports to ensure timely payments and reduce overdue balances
- Processed and reconciled credit memos, adjusting accounts payable balances as necessary
- Handled and maintained accurate records of all accounts payable transactions and vendor communications
- Managed the preparation of weekly, monthly, and quarterly accounts payable reports for internal auditing and management review
- Ensured adherence to healthcare compliance regulations, including HIPAA and other relevant laws, when processing payments and managing vendor relations
- Collaborated with internal departments, including procurement and finance, to streamline accounts payable processes and resolve any payment-related issues
Education
Master of Science - Information Systems
Northwest Missouri State University
Maryville, Missouri, USA12.2024
Bachelor’s of Science - computer science
Bhavans Vivekananda College
India06.2019
Skills
- My SQL
- Mongo DB
- Splunk
- OOPs concepts in Java
- OOPs concepts in Python
- Microsoft Word
- Excel
- Confluence
- Selenium
- Knowledge of GDPR
- Knowledge of HITRUST frameworks
- Ability to use SQL
- Exposure to Robotic Process Automation
- UiPath
- Automation Anywhere
- Familiarity with HL7
- Familiarity with FHIR
- Familiarity with DICOM
- Expert in verifying insurance eligibility
- Payment Posting
- Denial Management
- Authorization Tracking
Accomplishments
- Certified as good team player.
- Best performance award for maintaining quality and financial accuracy.
- Earned 'Spot Award' for outstanding contribution during high-volume project deadlines.
- Recognized for spearheading team-building sessions.
- Received monthly 'Client Delight' badge twice.
Rcm Skills
Expert in verifying insurance eligibility and benefits.
Accurately posted payments and adjustments.
Identified root causes for denials.
Monitored prior authorizations.
Timeline
Quality Analyst
AGS Healthcare
11.2021 - 07.2023
Process Coach
PrimEra Medical Technologies
01.2021 - 11.2021
Accounts Receivable Specialist
R1 RCM
08.2019 - 01.2021
Accounts Payable Specialist
Sutherland Global Services
08.2018 - 08.2019
Master of Science - Information Systems
Northwest Missouri State University
Bachelor’s of Science - computer science
Bhavans Vivekananda College
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