Poonam Priyadarshini

Managing Complete RCM Busines :-

• Client Portfolio Management: Oversaw a diverse portfolio, including clients from Behavioral Health, Physician Billing, and Laboratory Services, such as genetics, UTI, RPP, and blood tests.
• Client Onboarding & Integration: Led the onboarding process for clients, payers, and Electronic Data Interchange (EDI) enrollment, collaborating closely with the implementation team to ensure seamless transitions.
• Strategy Design & Implementation: Developed customized work strategies based on trend analysis and client-specific issues to optimize operational efficiency and minimize risk.
• Revenue Optimization & Loss Mitigation: Ensured projects achieved high revenue generation while minimizing business losses through meticulous planning and execution.
• Operational Auditing: Created and implemented a robust audit methodology to maintain error levels within acceptable thresholds, preventing client escalations and ensuring quality control.
• KPI Management: Monitored and managed key performance indicators (KPIs) in line with industry standards, including AR Days, Rejection Rate, First Pass Rate, and Denials, to ensure optimal performance and client satisfaction.
• Escalation Management: Developed and maintained an effective client escalation metric, addressing concerns promptly to maintain high levels of client satisfaction and retention.
• Team Leadership: Fostered a positive work culture with a growth mindset, motivating and guiding teams to deliver high-quality results consistently

Managed various scopes of RCM :-

• Oversaw all aspects of Revenue Cycle Management (RCM), including:

- Benefit Verification

- Billing and Rejections

- Accounts Receivable Follow-ups & denials

• Spearheaded client communication and conducted monthly business reviews to assess performance, resolve challenges, and ensure compliance with contractual Service Level Agreements (SLAs).
• Designed and implemented a KPI tracking mechanism to consistently achieve outcomes exceeding industry benchmarks.
• Led and managed a high-performing team while maintaining an attrition rate of less than 7%.

Patient AR Collection & RCM Billing Team :-

• Developed and implemented a collection strategy to enhance both collection efficiency and team performance
• Conducted in-depth inventory analysis to identify areas for improvement and optimize outcomes
• Managed billing operations for both legacy and ongoing accounts for a major enterprise laboratory services provider in the U.S
• Led a high-performance, productivity-driven team, ensuring a balance of both quality and efficiency in daily operations

Patient AR Collection :-

• Managed monthly and yearly collections goals to ensure targets were met
• Oversaw the team's call quality to maintain high standards of patient communication
• Ensured all patient communication adhered to state regulations and FDCPA (Fair Debt Collection Practices Act) laws
• Supervised the generation and distribution of monthly patient statements to ensure accurate billing and timely payments
• Managed team attrition shrinkage

Team Leader AR & Denial Management:-

• Enhanced revenue cycle operations and streamlined collection processes, driving increased company revenue.
• Minimized denials and underpayments by implementing effective KPI monitoring and reporting.
• Improved billing accuracy and reduced claims rejections.
• Addressed clearinghouse rejections and setup issues, ensuring smoother claim processing.

Team Mentor - AR Follow-ups & Denial Management :-

• Oversaw team productivity and ensured high-quality performance
• Addressed system edits and improved denial management
• Collaborated with internal and external stakeholders to implement effective billing practices, leading to increased revenue

AR Associate & Denial Management :-

• Handled various claim denials and EDI rejections, identifying and resolving trend issues to prevent recurring errors
• Consistently met assigned productivity and quality targets, ensuring accurate and timely claim resolution

• Worked on pain management and podiatrist speciality
• Performed AR follow-ups
• Worked on various types of denials

• Handled various claim denials, including non-covered services, medical necessity issues, and coding inconsistencies. Ensured accurate resolution of denials while maintaining defined productivity and quality targets