Shaji R

* Lead end-to-end US healthcare revenue cycle operations, managing complex claims adjudication, 835/837 EDI transaction integrity, and financial adjustments.
* Drive payment automation workflows to detect and resolve claim discrepancies prior to clearinghouse submission, reducing aged AR write-offs.
* Partner with operational and technical stakeholders to streamline clearinghouse error resolution.

* Handled full-cycle medical billing operations including charge entry review, clearinghouse rejection scrubs, Verified patient eligibility, benefits breakdown, and authorization requirements to prevent upfront denial triggers.
* Maintained daily and weekly cash collections reports, identifying denial trends and escalating systemic carrier processing delays.

End-to-End Adjudication: Adjudicated high-complexity Hospital (UB-04) and Physician (CMS-1500) medical claims using system software, applying complex business rules to determine final processing outcomes (Pay/Deny) for Surgery, Radiology, and Pathology services.

Adjustment & Appeals Management: Reworked denied claims, formal appeals, and provider resubmissions driven by AR executive work orders;

Grade: 83.03%

Activities and societies: Student Government

5th rank in the academic year of the school

Grade: 60.40%

Activities and societies: Student Government

Grade: 49.30%

Activities and societies: Student Day Scholar

Did night shift/Part time job to pay my semester fees