Revenue Cycle Analyst - Billing & Denials

Pravallika Gummadivelli

Revenue Cycle Analyst

***************@*****.*** LinkedIn (940) 808 - 5040 USA Revenue Cycle Analyst with 3+ years of experience managing healthcare billing, claims, denials, A/R, eligibility, prior authorization, payment reconciliation, and reimbursement analysis across U.S. healthcare operations. Processes 150+ claims and account transactions weekly while analyzing payer trends, coding discrepancies, and reimbursement variances using SQL, Python, Excel, and RCM platforms. Improved cash recovery by identifying $300K+ in annualized reimbursement opportunities and increased billing workflow productivity by 22% through automated reporting and variance analysis. Holds an M.S. in Health Informatics and a Certified Revenue Cycle Representative (CRCR) credential, with expertise in Medicare, ICD-10, DRG, HIPAA, and revenue cycle analytics. PROFESSIONAL EXPERIENCE

Revenue Cycle Analyst Ernest Health Aug 2025 – Present

• Reviewed eligibility and secures prior authorization for rehab and LTACH admissions by validating coverage in MEDITECH and confirming Medicare eligibility via DDE, handling 50+ admissions weekly to prevent authorization denials.

• Generated and submits UB-04/837I claims for rehab and critical care services using Oracle Health (Cerner) and RelayHealth, applying DRG/ICD-10-PCS coding for first-pass acceptance.

• Analyzed denial trends across authorization, medical necessity, and coding categories by tracking payer responses in Optum360, querying data using SQL, and identifying patterns in Advanced Excel, reducing preventable denials by 18%.

• Investigated payment variances and underpayments by comparing expected IRF/LTACH reimbursement against actual payer remittances in 3M CDIS, using Python to automate variance calculations, recovering $25K+ in underpaid claims monthly.

• Monitored A/R aging and DNFB (Discharged Not Final Billed) accounts by segmenting outstanding balances by payer and aging bucket in Crowe RCA and building KPI dashboards in SSRS, reducing A/R exceeding 90 days by 12%. Revenue Cycle Specialist Anion Healthcare Jan 2022 – Aug 2024

• Verified patient insurance eligibility and coverage details prior to service by pulling demographic data from Epic and running real-time benefits checks through Availity, processing 100+ patient accounts daily to reduce coverage-related claim rejections.

• Prepared and submitted physician and facility claims for US healthcare clients using eClinicalWorks and Waystar, applying ICD-10-CM coding to identify billing errors before payer submission and improve first-pass claim acceptance.

• Conducted billing audits and denial pattern analysis by reviewing payer rejection codes in Change Healthcare and querying claim-level data in SQL to identify revenue leakage across payer and CPT code categories, resolving 40+ denials per week.

• Processed claim appeals and reconciled payments by cross-checking claims adjudication outcomes in Trizetto against payer edit logic in ClaimsXten, correcting underpayments and adjustments on 200+ transactions monthly.

• Managed AR follow-up and compliance monitoring on outstanding insurance balances by tracking aged accounts through work queues in Q360 and reviewing balance/payer correspondence in Kareo, reducing unresolved AR beyond 90 days by 15%.

• Built AR aging and revenue performance dashboards in Power BI using collections data pulled from NetSuite Analytics, supporting HIPAA- aligned documentation standards and maintaining 97%+ audit accuracy during internal quality reviews. PROJECTS

Patient Financial Responsibility & Propensity-to-Pay Model

• Researched patient payment behavior, insurance responsibility splits, and demographic/financial data across simulated self-pay and high- deductible claims to identify payment predictors, improving simulated collection rate by 19%.

• Created a propensity-to-pay model segmenting patients by collection risk using claim-level cost-sharing data from Waystar Patient Estimation, achieving 80% classification accuracy and guiding personalized billing strategies.

• Developed an automated communication workflow triggering tailored payment reminders by risk segment, integrating Experian Health eligibility data to refine outreach timing and support a 19% improvement in simulated collection rate. Tech Stack: Python, SQL, Scikit-learn, Pandas, NumPy, Tableau, PostgreSQL, Waystar Patient Estimation, Experian Health, Git, Jupyter Notebook, GPT-based personalized messaging generation.

EDUCATION

Master of Science (M.S.) in Health Informatics, University of North Texas, USA Aug 2024 – May 2026 Bachelor of Pharmacy (B.Pharm), Anurag University, Telangana, India Jul 2020 – Apr 2024 CERTIFICATIONS

• Registered Pharmacist – Telangana Pharmacy Council

• Pharmacy Technician Trainee – Texas State Board of Pharmacy

• Introduction to Clinical Data – Stanford University.

• Certified Revenue Cycle Representative.

TECHNICAL SKILLS

• Research Methods and Analysis (INFO 5080).

• Graduate Academic Certificate in Health Data Science

• SQL Beginners to Advanced for Data Professionals

• Programming & Data Analysis: Python, SQL, PostgreSQL, Pandas, NumPy, Scikit-learn.

• Revenue Cycle Management Platforms: MEDITECH, DDE, Oracle Health (Cerner), RelayHealth, Optum360, 3M CDIS, Crowe RCA, Epic, Availity, eClinicalWorks, Waystar, Change Healthcare, TriZetto, ClaimsXten, Q360, Kareo, NetSuite Analytics, Waystar Patient Estimation, Experian Health.

• Claims & Medical Billing: UB-04, 837I, ICD-10-CM, ICD-10-PCS, CPT, DRG, Medicare, HIPAA.

• Denials, A/R & Reimbursement: A/R Aging Analysis, Denial Analysis, Payment Variance Analysis, Revenue Leakage Analysis, KPI Reporting.

• Business Intelligence & Reporting: Advanced Excel, Power BI, Tableau, SSRS.

• Predictive Analytics & AI: Propensity-to-Pay Modeling, Classification, Risk Segmentation, Predictive Analytics, GPT-Based Personalized Messaging Generation.

• APIs, Automation & Development: Twilio API, Automated Workflows, Jupyter Notebook, Git.

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