Senior Quality Specialist, MBA, CPC.

11 years of experience in medical coding, Auditing and billing with good management and leadership skills.

 Skilled in ICD 10,CPT,E/M ,ED facility and professional Coding and auditing, denial management.
Good verbal and written communication.

Demonstrates strong leadership skills and an ability to train and motivate team members.
A strong professional with MBA-operations management and a bachelor of Bachelor of Commerce from Delhi University.

  Jangpura, Pant Nagar, New Delhi, Delhi, India


November 2015 - Present

Senior Quality Specialist

R1RCM Global Private Ltd.

It is a KPO organization, having their head office in Chicago, USA. R1RCM is a leading provider of healthcare revenue cycle management services.

Job responsibilities

Proactively involved checking the quality, interacting with the coder and sending them daily,
weekly & monthly, quality reports and preparing dashboards.

Proactively manages all queries in relation to medical coding.
Leads/participates in quality improvement projects and actions as appropriate.

Communicates effectively with key stakeholders of all the assigned projects. Manage day to day operations of the department, including coordination, prioritization, personnel supervision and issues resolution of coding. Review distribution of work within
the coding team.

Providing individual feedback to the coder based on the quality report and other feedback to improve job efficiency.

Gained Depth knowledge in Outpatient ED/E/M, SDS/RAD/ANC setting and CPT code and Modifier mapping.

Doing Prebill Audit for the smooth transaction of a new process.

Work Experience

March 2014 - November 2015

Sr. Medical Coder

UHG Private Ltd

UnitedHealth Group Incorporated is an American for-profit managed health care company based in Minnetonka, Minnesota. It offers health care products and insurance services.

Job responsibilities

Accurately assigning ICD-10 and/or CPT-4 codes in accordance with Coding Departmental guidelines, they maintain no less than 98% accuracy in choice and sequencing of codes.

Worked on the ICD 10 Special project & conducting dual coding for ICD 9 and 10.

Worked on ED Facility and E/M project.

Participates in coding meetings and education conferences to maintain coding skills and accuracy

January 2013 - March 2014

Medical Coder

Elico Healthcare service

The Company provides remote processing services to Medical Billing Companies Ambulance
Billing Companies, Surgery Centers, Nursing Homes and Hospitals based in the USA, UK & the Middle East.

Gained in Depth knowledge of coding techniques and guidelines of medical coding ICD,
Responsible for translating the health care provider's diagnostic and procedural phrases
into Coded form by reviewing and analyzing the health records to identify the relevant
diagnosis and procedure for the distinct patient encounter.
Worked on ED Facility, Office Visit, encounter.
I went onshore on a training project in Alaska for 3 months.

August 2008 - April 2012

Process Trainer

Accretive Health Private Ltd  

Conduct Basic Healthcare/HIPAA, RCM Training of new and existing employees.

Verifying Insurance Eligibility, Updating Patient Demographics, Charge Entry, Hospital and Physician billing Claims, Posting of Payments, Work on Denials.

Conduct Process Training of new joiners and existing employees.
Attend Conference Calls/WebEx training regularly along with the required team members

I Have Attended L&D training classrooms like Accountability & Building ownership and
process related to training that helped me to develop my individual personality apart from
my daily roles and responsibilities.
Migrated Medicaid US Healthcare process from Michigan US office and worked
closely with clients in bringing the process to BAU stage

Migrated US Medical Billing US Healthcare based process from Michigan US .


2021 Completed 

SCDL University

Masters in operations management

2007 Completed 

Delhi University

Bachelor of Commerce

2004 Completed 

The Air Force School, Delhi



   Accountability      Verbal and Written Communication      Time Management Skills      Strong Leadership      Flexibility      Decision Making      Excellent Communication      Attention To Detail      Critical Thinking and Problem Solving      Adherence To Deadlines   


   English — Fluent      Hindi — Fluent   

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