Swetha Ramachandran

Revenue Cycle Management:

I am involved in all stages of account management, spanning from pre-sales discussions and collaborating with marketing managers on tailored sales pitches to facilitate deal closures, to orchestrating new client onboarding processes and overseeing RCM operations for 30+ practices across specialties and States.

Team Leadership: Hire, train, and oversee the performance of a team of RCM Operations Coordinators by setting clear expectations (KRAs), monitoring their performance with objective KPIs, and providing constructive and timely performance evaluations.

Collaboration with offshore teams: I work very closely with the offshore teams and liaison between the clients and the team. I create playbooks for each process based on client's requirements, set goals and track data-driven performance for all the teams in the life cycle of Revenue cycle management from Provider credentialing, pre-visit Eligibility verification, Prior authorization, coding, billing, denial management, AR management, payment posting, managing unpostables, and underpayment and overpayment analysis.

Reporting: I specialize in creating reporting templates and dashboards to provide data-driven insights on all the RCM metrics like Charge entry lag, Clean claim ratio, First pass resolution rate, Days in AR, AR aging buckets, etc. to improve the billing process.

Financial health management: I create customized reporting for Revenue projections, Cash waterfall analysis, Collection yield ratio, Revenue run rate and NRPV analysis for managing the practice's financial health.

I also manage Staffing forecasts and invoicing of clients on a monthly basis.

• Managed the Tier-2 Customer Care (portal support) team for Athena's product supporting Quality Pay for performance programs
• The job involved understanding and keeping abreast of the industry updates for all Quality programs supported (MIPS, Medicaid PI, HEDIS, UDS, etc.) and the corresponding product changes to support healthcare providers for better performance
• I successfully managed the high case inflow during program submission deadlines by creating staffing forecasts, effective planning and execution.
• Effective management (and resolution) of escalations from customers
• Resolve and prioritize key customer issues through cross-functional efforts - collaborating with Product, Engineering, Voice of the Customer, and Operations
• Serve as the critical communication channel between customers and Product Engineering teams to influence enhancements and innovative features through data analysis.

• Initiated my career in 2007 as a Credentialing Specialist, where I was responsible for completing payor credentialing applications and following up with the payors on pending enrollments.
• In 2010 , I was promoted to Credentialing Team leader, taking on additional responsibilities of overseeing the credentialing team.
• Lead the implementation of mapping payor applications into Omniform (OneApp Pro Symed) to auto populate information from the software. Provided training and mentorship to new team members, fostering a collaborative and knowledgeable team environment.
• In 2013 , proactively requested a shift to Revenue Cycle Management (RCM) from provider credentialing to expand my knowledge and skills. Manager a team of RCM analysts for an Internal medicine based practice.
• In 2015, I was promoted to Assistant RCM Manager where I headed 3 service lines in the Account Receivables division that handles Follow-up, Denial Management and Quality Audits. Managed a headcount of 62 analysts and 3 service line managers.