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Nadim Shaikh

@nadimshaikh1

Message

RCM Operations Team Leader specializing in denials management and medical billing excellence for U.S. healthcare.

India

Message

What I'm looking for

I’m looking to grow within U.S. healthcare RCM where I can lead teams, reduce denials, improve cash flow, and deliver accurate, compliant claims operations through strong training, reporting, and continuous process optimization.

I lead RCM operations with a focus on Workers' Compensation, Personal Injury, and professional medical claims across multiple U.S. healthcare specialties. I’m known for optimizing processes, reducing denials, improving cash flow, and strengthening operational efficiency while maintaining strict HIPAA compliance.

As Team Leader - Operations, I manage an RCM team of 10 FTEs and oversee end-to-end claims management—from denial resolution to claims aging and adjustment reporting. I coordinate with clients and internal stakeholders, track team productivity through performance metrics, and train teams on payer-specific guidelines, compliance requirements, and system changes.

Previously, I served as SME - Denials Management, leading 15 denial management specialists and improving accuracy by analyzing root causes and updating SOPs. I also built hands-on expertise as an RCM Specialist and in Accounts Receivable, processing paid/denied claims, validating coverage and patient responsibility, managing work queues, and documenting outcomes for audit and reporting.

Experience

Work history, roles, and key accomplishments

Current

Team Lead - RCM Operations

Current

Quantanite

Jan 2025 - Present (1 year 5 months)

Lead the RCM operations team managing Workers' Compensation, Personal Injury, and professional medical claims across multiple specialties. Manage a team of 10 FTEs for denial resolution and end-to-end claims management while maintaining HIPAA compliance and delivering training, reporting, and performance tracking.

RCM Operations Denials Management Claims Management HIPAA compliance Workers’ Compensation Athena

SME - Denials Management

Bizmatics

Jan 2024 - Jan 2025 (1 year)

Led a team of 15 denial management specialists, ensuring timely and accurate resolution of claims. Developed targeted training, updated SOPs, handled client escalations, and analyzed complex denials to reduce repeat issues.

Denials Management Claims Analysis Root Cause Analysis Team Leadership Training Enablement

RCM Specialist

EClinicalWorks

Jan 2021 - Jan 2023 (2 years)

Submitted electronic and paper claims and processed paid and denied claims according to payer guidelines and adjudication criteria. Investigated complex claim issues, ensured HIPAA-compliant documentation, followed up on denials, and verified coverage, patient responsibility, and insurance payments.

Medical Billing Claims Adjudication HIPAA compliance Medical Terminology Insurance Verification

Accounts Receivable

Gebbs Healthcare Solutions

Jan 2019 - Jan 2020 (1 year)

Reviewed claims for accuracy and routed them to the correct insurance carriers for processing. Managed denial/rejection/no-response queues, contacted insurers and patients for missing information, processed adjustments, and maintained documentation for audit and reporting.

Insurance Claims Processing Patient Outreach For Coverage Updates Claims Documentation Audit Reporting