Mohit Pratap
@mohitpratap
US Healthcare RCM Specialist specializing in eligibility verification and prior authorization for Radiology and Vascular care.
IndiaWhat I'm looking for
I’m a US Healthcare RCM Specialist with 3+ years of experience in Eligibility Verification and Prior Authorization for Radiology and Vascular services. I manage high-volume payer interactions with major US insurers, maintaining 98%+ accuracy while minimizing denials.
In my current role, I handle 40–60+ cases daily across the end-to-end authorization and eligibility workflow. I perform outbound calls to US payers for authorization and benefit details, ensure accurate documentation to reduce front-end denials, and train new hires on medical terminology and payer communication.
Previously, I worked as a DBC Eligibility Verification Associate, where I delivered high-volume eligibility verification with 98%+ accuracy. I verified benefits, co-pays, deductibles, and patient responsibility, and used payer portals for real-time updates while coordinating with providers and insurers to resolve discrepancies.
Experience
Work history, roles, and key accomplishments
Authorization & Eligibility Specialist
Prohealth Business Solutions
Apr 2024 - Present (2 years 2 months)
Manage end-to-end eligibility and authorization for radiology and vascular cases, handling 40–60+ cases daily. Conduct outbound payer calls, ensure accurate documentation, maintain HIPAA compliance, and train new hires on payer communication and medical terminology.
Eligibility Verification Associate
DBC
Apr 2023 - Apr 2024 (1 year)
Performed high-volume US healthcare eligibility verification with 98%+ accuracy, validating benefits and patient responsibility (co-pay, deductible, co-insurance). Coordinated with providers and insurers to resolve discrepancies using payer portals.
Education
Degrees, certifications, and relevant coursework
Shubharti University
Master of Business Administration, Business Administration
Completed a Master of Business Administration (MBA) at Shubharti University.
Shubharti University
Bachelor of Business Administration, Business Administration
Completed a Bachelor of Business Administration (BBA) at Shubharti University.
Tech stack
Software and tools used professionally
Availability
Location
IndiaAuthorized to work in
Job categories
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