Ashfaq Ali Mohammed

Managed daily inventory distribution and set production targets aligned with team capacity. Conducted weekly audits ensuring 98%+ accuracy in calls and claim notes. Led onboarding and refresher training on complex payer policies. Facilitated 1-on-1 performance reviews focusing on KPIs like productivity, quality, and resolution rates. Acted as primary escalation contact for complex claim issues. Prepared and presented weekly/monthly RCM performance reports to stakeholders. Monitored AR aging to prioritize high-value, critical claims, ensuring efficient revenue cycle management.

Responsible for managing daily healthcare operations to ensure optimal service delivery. Conduct quality audits on medical claims (UB-04) to verify accuracy, compliance, and alignment with payer policies. Analyze claim denials and rejections to detect error patterns and propose corrective measures. Validate denial reasons according to payer guidelines and document results to facilitate timely resolution and improved reimbursement processes.

Managed accounts receivable follow-up, claims resolution, and denial management by engaging US insurance carriers to verify claim status and identify denial causes. Verified insurance eligibility, updated payer information, and performed rebilling. Filed retro-authorization requests and appeals supported by medical necessity documentation. Reviewed UB-04 forms for accuracy, audited claims against medical records, and ensured compliance with payer guidelines. Coordinated with insurers, patients, and internal teams to expedite reimbursements. Maintained strict adherence to HIPAA and company policies while handling sensitive healthcare data.

Handled inbound and outbound calls for US healthcare clients, ensuring efficient communication and customer service. Coordinated with insurance companies and payers to verify and follow up on claim statuses. Assisted in resolving billing discrepancies, conducting thorough investigations, and escalating complex issues to appropriate departments for timely resolution. Maintained accurate records and ensured compliance with company policies and healthcare regulations to support seamless claims processing and enhance client satisfaction.