Bismillah Hirrahman Nirraheem, subhanallah wabihamdihi, subhanallahilazeem

CURRICULUM VITAE

Syed Ali Rizwan Email : adzgc6@r.postjobfree.com

Phone : +91-964*******

Career Objectives

To associate with an organization, this gives an adequate opportunity to display knowledge and professional skills in the chosen profession through continuous learning and development. I would like to enhance the growth of the organization, if given an opportunity I will put in my best effort with full enthusiasm and accomplish the task on time with quality. PROFESSIONAL SYNOPSIS

Proven abilities in Operations Management, Client Relationship Management, and Transition Management. Ensuring end-to-end Process Mapping of processes and defining SLAs to ensure smooth transitions. Driving continuous experience for pilot processes. Experienced in handling conflict management.

Having well versed understanding and experience in P&L, Gross Margins projections, meeting SLA, thorough understanding of EBITDA (Gross and net profit evaluation),

Experienced in handling Contingency, transaction and FTE business models and invoicing accordingly.

Well versed in Planning, executing, and finalizing projects within triple constraints of delivering on time, within budget and scope objectives, including acquiring resources and coordinating efforts of team members in order to deliver projects according to plan. Identify, effectively communicate, and resolve project issues and risks. Effectively communicate Project status to Project Stakeholders.

Exceptional skills in communication, presentation & mentoring to ensure thorough accountability for end-to-end Process Management

Functioning as an active part of the Escalation Matrix thereby, ensuring agile and effective Solution Management for critical issues.

Operational / Managerial Role / Operations Management

Ability to develop a scoreboard to monitor progress, train the new team, develop detailed procedures, flowcharts, and a measurement framework to smoothen the process

Setting up targets/ goals for the process – setting and maintaining Critical to Quality & Critical to Process targets for the process.

Coordinating integration with support functions viz. Quality, Training, Compliance & HR. Quality & Compliance

• Setting up a robust Quality Management System based on Client requirements

• Conducting continuous audits on MIS to ensure compliance and sound functioning of the process.

• Ensuring that the teams adhere to all the quality tool and procedures.

• Taking initiatives through various programs that the team members to all the policies and procedures Training & Development

Determining training needs and conducting programs to enhance efficiency in operations towards the accomplishment of corporate objectives.

Instrumental in bridging the communication gap between the team of auditors and the operation team.

Adept at compiling effective Training Need Analysis to ensure process control and seamless process functioning.

Monitoring the performance of employees to ensure efficiency in operations and meeting of KRAs.

Conducting performance reviews of members and providing feedback on areas of improvement. Client Servicing

Identifying improvement areas & implementing measures to attain customer satisfaction levels.

Taking escalations for resolving critical issues; ensuring CTQ Delivery & Business Continuity.

Ensuring continuous interaction with the customer to make sure that area of concern can be worked upon for improved service levels.

Experience Summary

Over-all 17 years of effective experience in Medical Billing – end to end RCM with handling maximum team size of 200 people includes of direct and indirect reportees, working experience with direct and indirect hierarchies with an exposure to multiple specialties as follows: Hospital billing (end to end), Skilled Nursing Facility (end to end), Alcohol and Substance abuse (end to end), Physician outpatient billing (Specialty: Endocrinology, psychiatric, DME & HME services, Laboratory services, Internal Medicine and Multi-specialty practices), RHC & FQHC billing.

Well versed in end-to-end RCM - Accounts Receivable, Credit Balance, Payment Posting, Correspondence review, Denial management, Data verification, Billing, Rejections, Eligibility & Benefits verification, Scrub and Triage for both Professional and technical service providers in US health care industry. Provided support with recognized strengths in account maintenance, problem-solving, troubleshooting, staff support. planning/implementing proactive procedures.

Possess good computer skills. Excellent working knowledge using Microsoft Office - Word, Excel, PowerPoint and Outlook.

Skillful to Train, Motivate and Supervise multi operational and support teams (Training, Quality, Automation, Transition & client services and Finance team on monthly Invoicing)

I am an enthusiastic dedicated professional with extensive experience across RCM functions in US healthcare industry. A proactive individual with a logical approach to challenges and utilize my expertise to perform effectively and efficiently even during highly pressurized situations.

Gained spectacular exposure being part of process excellence, Transition and operations since beginning of my career in medical billing.

Training & Skills

Have undergone supervisor/management level workshop like leadership and people management training, Project Management, Essentials of management.

Completed projects for team Productivity Improvement, Aging reduction, Error percentage reduction & Cost reduction.

Standardized Process and Procedural and prepared process manuals for SNF facilities, Hospitals, Home health Care & Physician billing credit balance process in the year 2010.

Preparing to appear for AAHAM examination to be certified with CRCP-CRCP-P. & I

Pursuing Six Sigma Green Belt.

Organizations Worked

Current Employer: Miramed Ajuba Solutions (currently – Coronis Ajuba) Title : Joined as Senior Manager Delivery Operations Duration : December 2022– till current.

Project : Hospital Billing / Physician Billing

Software / Tools : PMS - Kareo, Meditech, ECW, Point Clickcare, Leadership Responsibilities: Coronis projects transition, P&L accounting, Monthly Invoicing, staffing evaluation, leadership evaluation, User and Leadership Interviews, Identifying and placing right expertise according to the roles and positions available, Providing Road map to the leaders and users, driving team on SLA on production, quality and staffing, Quality meetings for setting up parameters according to process requirements. Achievements:

Successfully Transitioned and settled 6 projects with 15 sub projects and streamed lined.

Streamed lined the WFH / WFO environment to be productive, Stabilized deliverables and brought up client satisfaction

Identified the Areas of improvement from Production, quality, staffing and training aspects and provided road maps to each department according to the requirements, stabilized quality parameters and training curriculum along with SOPs for stabilization.

Removed individual dependency in the process by cross training new resource and making capable of working on multiple activities efficiently.

Handled team during resource crunch with under resourcing since the day one and make available resource capable of over achieving targets to compensate the deficit numbers due to resource crunch.

Implemented and helped software automation team with ideas to develop internal workflow tool (Aspire) from outpatient physician claim tracking set-up to Inpatient claims tracking set-up.

Took governance on the process and stabilized quality team training team by redesigning the quality and training module and made it very time efficient with better outputs. Current Employer: Omega healthcare Services (Chennai) Title : Joined as Senior Manager Operations Delivery Duration : October 2021– November 2022.

Project : SNF Billing, Physician Billing

Software / Tools : Billing Applications - Point Click care, Medicare DDE system, Quadax, Myability, Waystar Share point, SFTP file movements, One drive for data communication with client and other insurance web portals Achievements:

Started with one of the potential and platinum client specialized in SNF services. Being SNF and inpatient billing specialist brought an improvement with 300% increase in business within 6 months of tenure and stabilized the project with all standardizations put in place.

Removed individual dependency in the process by cross training new resource and making capable of working on multiple activities efficiently.

Stabilized deliverables and brought up client ratings which was sinking below 5/10 since the date of contact to 7/10 in first quarter and latest 8/10.

Handled team during resource crunch with under resourcing since the day one and make available resource capable of over achieving targets to compensate the deficit numbers due to resource crunch.

Implemented and helped software automation team with ideas to develop internal workflow tool(Aspire) from outpatient physician claim tracking set-up to Inpatient claims tracking set-up.

Took governance on the process and stabilized quality team training team by redesigning the quality and training module and made it very time efficient with better outputs. Responsibilities

Monitoring and controlling business compliance in all areas, including Client calls, effective planning, staff training and development, organization and time management.

Managing Institutional billing projects for (SNF, Substance Abuse – Facility residential & inpatient billing)

Developing project plans based on available resourcing and maintaining shrinkage and Attrition by retraining resources and them gain confidence with knowledge and controlled attrition.

Responsible for end-to-end process monitoring and controlling right from eligibility verification to denial management managing & reporting

Bi-Weekly PPTs and performance review with client.

Team building, doing refresher and knowledge transfer session with new agents and at times existing team to cover gaps

Guidance to team leads in prioritizing inventories and work allocation, monitoring and driving Targets to meet client SLA

Preparing monthly Invoices to client, controlling Shrinkage and Attrition, Skip level meeting with TL and users separately

Always ready to get involved in transition with prospective clients. Organization : Sun Knowledge (Kolkata)

Title : Joined as Assistant Manager Operations, Promoted as Operations Manager. Duration : April 2016 – September 2021

Projects : SNF Billing, Alcohol & Substance Abuse, DME & Physician Billing (psychiatric, dermatology services) (End to End)

Software / Tools used: Billing Applications - KIPU, CollaborateMD, Kareo, Fastrack, NextGen, Point Click care, Klein System, PC Ace, Esolutions, Medicare Passport system, Myability, Availity Responsibilities

Managing big team size with multiple specialty processes end to end RCM services for SNF facility in patient and Physician billing, Genetic Testing laboratory services, Alcohol and substance abuse billing inpatient and outpatient, psychiatric services outpatient billing.

Monitoring and controlling business compliance in all areas, including Client calls, effective planning, staff training and development, time to time quality measures and time management.

Managing Institutional billing projects for (SNF, Substance Abuse – Facility residential & inpatient billing)

Developing project plans based on available resources

Recently started with new process for DME billing (Durable Medical Equipment - professional billing)–under transition

Responsible for end-to-end process supervision right from eligibility verification to denial management

Daily, weekly and monthly client calls, process metrics, PPT preparation and daily reporting to clients.

Weekly and Monthly Project review with client

Team building, doing refresher and knowledge transfer session with new agents and at times existing team to cover gaps

Allocation of work, monitoring and driving Targets to meet client SLA

Scheduling weekly meeting with client in project review

Undertaken transition for new projects with accomplishing following tasks (Process Manual preparation based on client specialty, get IT infrastructure set-up for new client, remote desktop setup, SFTP folders to share documents, FTE allocation based on project size, conducting Knowledge transfer sessions, setting expectation between client & management, finalizing the process flow, folders set-up at ISO standards, analyzing daily volume to set production targets.

Taking care of Client Invoices, Team attendance, Shrinkage control, Attrition control, Skip level meeting with team and individual employees, Individual reviews with different team members

Always ready to get involved in transition with prospective clients. 3. Organization : IKS Health (Hyderabad)

Title : Sr. Team Leader

Duration : September 2012 to April 2016.

Software / Tools used:NextGen Application & Availity, Zirmed, Payerpath (Clearing house), SFTP file transfers, Insurance web portals.

Joined as RCM Specialist and later Promoted as Team Leader for outpatient physician billing project (end to end). Responsibilities

Responsible for meeting SLA’s and production targets,

Developing project plans based on available resources to address outstanding inventories

Consistently achieving and surpassing Key Performance Indicators.

Doing Inventory Analysis, Categorization and Client daily reporting.

Planning, Strategizing, scheduling and implementing the process and client updates.

Allocation of work, monitoring and driving Targets to meet client SLA.

Controlling Team hygiene issues, requirements and leave requests post discussion with manager.

Doing Weekly and Monthly review with presenting the status on complete SLA & process with client.

Preparing weekly and monthly PPT on process Metrics and achievements

Reviewing and evaluating weekly & Monthly achievement and PPT preparation with the update on team progress.

SLA’s and Key measures to the management for internal tracking.

Follow process flow – (Track client escalations, updates and Issues)

Takes initiative to prevent the Client escalations with internal live audits and dead audits along with report audits

Take initiative on process analysis to prevent possible future denials.

Addressing client requests at top priority (follows TAT) sort of communication (Calls, Emails)

Supporting and coaching team members to reach their full potential,

Assignment of additional responsibilities among good performers to extend their knowledge and growth.

Maintain Team Attendance, over time data, bill, and other expenses for re-imbursement.

Monitoring and controlling business compliance in all areas,

Client calls, effective planning, staff training and development, organization and time management.

Maximizing opportunity by promoting the highest standards of customer care and recognizing potential development and training opportunities to increase revenue for both customer and organization.

Communicating daily with Operations manager & client – to ensure effective control and operation of all areas.

Providing regular performance feedbacks and always on the lookout in improving skills of team members.

Performance Management

Conflict Management

Responsibilities as a Specialist:

Research, Analysis and Resolution of claims. Educating Team on new trends and process flow.

Finding trends in coding and rejections in order to automate the team/project.

Assisting the team with a quick resolution and Assigning work order whenever necessary.

Team handling in the absence of team lead.

4) Organization : Sys Information (Mysore)

Title : Sr. AR Executive & Acting Team Lead.

Duration : May 2011 to September 2012.

Software /Tools used: M.D.BUG & Medicare DDE System &NextGen Sys Information Health care is a provider of BPO services in the healthcare domain in India and this is the only Indian BPO organization specializing both in the U.S. Hospital billing and physician billing in Mysore region, Company service Execution of Knowledge-Based Healthcare, Financials & Software development. Key Responsibilities as an AR and Patient Caller:

Doing follow up on denials within 24 hours TAT

Doing Patient AR follow-up and fixing the patients queries via inbound and outbound calling.

Maximum exposure on older AR to get the prevent Bad debts and crossing timely filing.

Making calls to patients to collect the Dues and old balances which are their Liability

Taking inbound calls on patient’s queries and resolving the account / bill related Issues.

Sending out the patient monthly statements.

Client reporting on monthly production and quality- Formats (MS Excel & PPT)

Communication with client to get the resolution on any sort of client Issue (technical, Domain or patient related)

E-mail communication & audio conferences with client on Weekly and Monthly process review. 5) Organization : Accurate Billing and Consulting Services (Hyderabad) Title : Process Transition Specialist, (SNF & Hospital) Inpatient and outpatient services Duration : May 2006 to March 2011

Software / Tools used: Vista Care, Soft Care, Office Ally, Medicare Passport system & PC Ace. ABCS is a provider of BPO services in the healthcare domain in India and this is only Indian BPO organization specializing both in the U.S. long term-care as well as in acute-care. Key Responsibilities under process Transition:

Doing Analysis on complete process & Client requirements

Planning, executing, controlling and reporting the process flow.

Understand the client requirement and direct the process heading to the right direction.

Cross verifying and reviewing the deliverable data to maintain the quality @100%. Key Responsibilities as a User:

Doing Follow-up with insurance companies and working on self-pay accounts

Doing patient calls to collect the Dues and old balances which are Patient Liability

Taking Inbound patients calls and resolving the account / bill related Issues

Worked on patient monthly statements.

Patient AR Follow-up

Maintain the data of the Skilled Nursing Facilities.

Updating daily census and checking the Eligibility, billing to State and Federal Insurance, Working on cash postings.

Follows the strategy and Immediate follow up on high value & Denial claims.

Communication with the Business Office Managers regarding queries in processing of accounts.

Looking into Cash Collection files and follows up for unrealized collections.

Preparing Private statements for the Residents in the Facility

Preparing Bank Reconciliation statements and reporting daily activities to the Process Manager.

Daily checking (Daily Deposit) and CCL (Cash Control Log) Accountability and Achievements:

Looking in to quality related issues and come up with better ways to achieve 100% quality.

Sending weekly productivity reports to Business Office Managers.

Resolving the issues and escalating to Managers if required.

Joined as a Process Associate and promoted as Senior Process Associate Then Process Transition Specialist

Consistently maintained 99% accuracy and met desired results keeping commitments.

Awarded as a Best Supporting associate from the Management.

Team handling experience at a well-organized level. Education Qualification:

Graduation: B.com Graduate

Intermediate from ST. Thomas Jr. college

S.S.C. from Adams High School

Skills Set:

Strong Analytical skills

Strong leadership and mentoring skills

Excellent verbal and written communication skills

Punctual and time-sensitive

Route cause analyst and problem solving.

Target, people and business oriented and resolution mind set with good negotiation skills.

Aptitude for customer care.

Knowledge of customer service and client reporting principles and practices.

Flexible to any shift according to client requirement.

Very Efficient in Microsoft Office Software up to business requirements

Efficient Typing speed of 40WPM (English)

Personal Information

Name : Syed Ali Rizwan

Father’s Name : Syed Yaseen Qamar

DOB : 4th June 1985

Gender : Male

Religion : Islam (Muslim)

Mother tongue : Urdu

Native Place : Hyderabad

Current Location : Chennai

Nationality : Indian

Languages Known: English, Urdu, Hindi, Telugu and {Arabic (reading)} Extra Activities : Listening music, Watching Animation & Action movies and Internet Browsing. Declaration: I hereby declare that the above-furnished information is true to the best of my knowledge. Syed Ali Rizwan

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