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Sushant Kashikar

@sushantkashikar

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Experienced Quality Analyst specializing in US Medical Billing and RCM.

India

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What I'm looking for

I am looking for a role that fosters quality improvements and offers opportunities for professional growth in the healthcare sector.

I am an experienced Quality Analyst with a robust background in US Medical Billing and Revenue Cycle Management (RCM), particularly in the Accounts Receivable (AR) domain. My expertise lies in analyzing claim denials, identifying process gaps, and ensuring compliance with payer guidelines and industry standards. I have a proven track record of enhancing process accuracy, reducing rework, and improving overall claim resolution rates through in-depth audits, root cause analysis, and performance feedback.

In my current role as a Quality Analyst/SME at First-Insight Solutions, I conduct regular audits of AR processes to ensure adherence to client SLAs and payer-specific guidelines. I analyze claim denials and provide actionable insights for process improvement. My commitment to driving quality improvements and operational excellence is reflected in my ability to create detailed quality audit reports and dashboards for management review. I also collaborate with training teams to develop quality training programs based on audit findings.

Previously, I served as an AR SME at Inventurus Knowledge Solutions, where I handled complex claim resolutions and provided ongoing process training to enhance team efficiency. My journey in the medical billing sector has equipped me with strong knowledge of HIPAA regulations and industry-standard EPMs, enabling me to support my team effectively and contribute to overall operational success.

Experience

Work history, roles, and key accomplishments

Current

Quality Analyst/SME

Current

First-Insight Solutions

Sep 2022 - Present (2 years 10 months)

Conducted regular audits of AR processes to ensure adherence to client SLAs, payer-specific guidelines, and internal quality standards. Analyzed claim denials, rejections, and underpayments to identify root causes and provide actionable insights for process improvement.

Denial Management Audit Root Cause Analysis Performance Analysis SOP Development Training HIPAA Regulations

SME/Quality Analyst

Inventurus Knowledge Solutions

Oct 2019 - Present (5 years 9 months)

Began tenure as an AR Subject Matter Expert (SME) in US Medical Billing RCM, specializing in Accounts Receivable follow-up and denial management. Handled complex claim resolution across various specialties and payers, including Medicare, Medicaid, and commercial insurance.

Accounts Receivable Denial Management Root Cause Analysis Audit Reporting HIPAA Regulations

Account Receivable (AR)

Gebbs Healthcare Solutions

Mar 2018 - Present (7 years 4 months)

Performed insurance follow-ups via phone calls and payer portals to resolve aged claims and ensure timely reimbursements. Worked on claims for multiple specialties including radiology, internal medicine, and DME, ensuring proper documentation and coding.

Insurance Follow Up Medical Coding HIPAA Regulations

Education

Degrees, certifications, and relevant coursework

ExcelR Raising Excellence

Certification, Data Science

Completed a Data Science Certification program at ExcelR, focusing on key concepts and applications in the field. This program enhanced my analytical skills and knowledge in data interpretation and management.

Saket College

Bachelor of Science, Chemistry

Earned a Bachelor of Science degree with a specialization in Chemistry from Saket College. This program provided a strong foundation in scientific principles and analytical methodologies.

Saket College

Higher Secondary Certificate, General Studies

Completed Higher Secondary education at Saket College, building foundational knowledge across various subjects. This period prepared me for further academic pursuits.

Devi Dayal School

Secondary School Certificate, General Studies

Completed Secondary School Certificate (10th grade) at Devi Dayal School. This foundational education provided a broad understanding of core subjects.