Santosh Rawat

Denial Analyst / RCM Specialist/Internal Acting Team Lead

●        Analyse insurance denials and identify trends to improve first-pass resolution rate

●        Perform root cause analysis and prepare RCM performance reports

●        Review and approve write-offs and manage credit balance accounts as per payer guidelines

●        Handle EDI rejections and ensure timely correction and re

•Accepting inbound calls to quote benefits and insurance verification.
•Explaining denials to providers and patients and organizing scanned EOBs.
•Handling patients, referral sources, and administrative department inquires
•Communicating with insurance companies and/or prior authorization requests
•Entering patient information into a customer information system
•Ensuring customer satisfaction and

•Ensuring claims are being submitted in a timely manner with quality work.
•Contacts insurance payors to retrieve claim status for unpaid medical/auto/worker's compensation claims.
•Contacts insurance payors to dispute unpaid/denied claims and appeal if necessary.
•Posting payments accurately that are received from insurance companies based on the explanation of benefits and remittances.
•Performi

Performed insurance follow-ups on denied, underpaid, and aged claims. Assisted in reporting and tracking collections and AR performance.