Headline

US Healthcare Denials & Audit Specialist | Acting Lead | High-Dollar Claims | Facets | HIPAA | Encore Award – Accenture | Payer guidelines | Medicare and commercial

About

US Healthcare professional with hands-on experience in Denials Management, Audit, and Revenue Cycle Management (RCM), currently functioning in an Acting Lead capacity.\n\nI have experience in denial root cause analysis, claims audit & quality review, high-dollar claims processing, and escalation management, along with training and mentoring team members to meet quality and TAT targets.\n\nMy role involves working closely with US clients, ensuring HIPAA compliance, interpreting payer guidelines, and supporting revenue protection and inventory reduction initiatives.\n\n🏆 Encore Award – Accenture (2025) for outstanding performance\n⭐ Consistent Weekly & Monthly Star Performer\n\nI am actively exploring opportunities in:\n• US Healthcare Denials / Audit\n• Revenue Cycle Management (RCM)\n• Senior Analyst / SME / Team Lead roles\n\n📌 Skills: Denials Management | Audit & QA | High-Dollar Claims | Facets | HIPAA | RCM | Team Handling\n\n📩 Open to discussions for growth-oriented US Healthcare roles.

Location

Mumbai

Work experience

Health admin new associate at Accenture, Aug 2023 - Present · 2 yrs 10 mos, Navi Mumbai

Claims Analyst at Accenture, Aug 2023 - Present · 2 yrs 10 mos, Act as a Team lead for US insurance claims processing and adjudication workflows Provide floor support including work allocation, escalation management, and production oversight Handle end-to-end processing of EDI, Fully Insured, and Medicare insurance claims Perform insurance claim audits to ensure accuracy, compliance, and adherence to payer policies Manage denial management lifecycle including root cause analysis, appeals, and resolution Review and process high-dollar insurance claims with strict compliance to underwriting and payer guidelines Identify claim discrepancies, error trends, and implement corrective actions to minimize financial leakage Collaborate with US-based clients, insurers, and stakeholders for requirement clarification and resolution Support regulatory compliance including HIPAA and insurance policy frameworks Conduct training sessions on insurance claims lifecycle, denial management, and compliance standards Mentor new hires and support cross-functional teams during peak volumes Drive quality improvement initiatives to enhance claims accuracy and turnaround time

Education

SMT. CHM College, Ulahasnagar - 03

Bachelor of Commerce, CHM