Parag Hadke

About Parag Hadke

Dedicated healthcare expert with ten years of hands-on experience in the complexities of medical practice business operations, billing and reimbursement in the US healthcare revenue cycle and financial services industry. I\'m an expert at employee training and process development, and I bring a problem-solving approach and a high attention to detail that allows me to analyze complex data and maximize productivity. My experience includes working together with a wide range of service providers and colleagues at various levels. Throughout my career, I\'ve had the opportunity to work with world-class healthcare IT companies, accumulating considerable knowledge in areas such as AR, EDI, EVBV, Authorization, referral processes and supporting Electronic Patient Record Applications. I am skilled at problem solving, product support, client administration, processing claims and health plans, and documenting workflows. My dedication to excellence is reflected in my ability to accomplish business objectives and improve client satisfaction, particularly in remote work circumstances, by communicating effectively with internal and external stakeholders. I bring substantial expertise in Health Insurance Claim Adjudication, Prior Authorization, Utilization Management and the Overpayment Recovery Process from a solid career spanning nine years in both the US healthcare insurance and provider domains. My expertise in Claims, Provider Enrollment, Provider Management, Prior Authorization and Practice Management Systems qualifies me as a dependable individual eager to contribute to the success of healthcare organizations.10+ years of expertise in US Healthcare, both insurance and provider.10+ years of experience in US Health Insurance Claim Adjudication, Prior Authorization, Utilization Management and Overpayment Recovery Process.Strong knowledge of Claims, Provider Enrollment, Provider Management, Prior Authorization and practice Management System. I\'m searching for new possibilities to use my expertise and make a difference. I\'m willing to meet with recruiters. Thank you for considering contacting me.

Experience

1. Senior Qa (Us Healthcare) Rcm

   Ascent Business Solutions

   Sep 2014 — Present · Nagpur, IN

   Auditing the AR, Authorization, referral & EVBV, EDI process. Identifying testingparameters for audit transactions per sample size, methods & techniques provided•Analyzed performance of Business Process Departments using practice managementsoftware to ensure adherence to company procedures and insurance payers policies.•Recommended steps to improve workflow and maximize quality and productivitystandards. Managed special projects with department managers to optimize physicianreimbursement.•Led all the departments to achieve optimum performance consistent with the companygoals and objectives.•Proficient in major PMS & EMRs (eCW, Allscripts, Nextgen, prognocis, citrix, Trizetto,Availity, Navicure, CurMD, Realmed, phreesia)•Developing and implementing quality control audit plans, work flow processes, ensurequality of Deliverables.• Ensure proper execution of projects, monitor the quality and provide feedback toindividuals or team on daily basis. Ensure all updates from clients are recorded.•Participate in conference calls with the clients/ top management on daily basis•Maintain HIPAA compliance throughout the organisation.Running monthly/ weekly/ annual reports based on CPT CODES, ICD10 CODES,PROVIDER, LOCATION, DATABASE etc, weekly scheduling assignment on softwaresystem for junior staff/ project dept, floor support on received correspondence from theinsurance cos, setting up process protocol for denials for further appeal Chatting, e-mailing, Conversing with Clients back in the U. S. Analysis/ QA Calling/Faxing the data reports.

Education

• Nagpur University

  Master of Technology - MTech

• Datta Meghe Institute of Management Studies

  Master of Business Administration - MBA, Ops - LGX & Mktg

  2017 — 2019

• Maharashtra State Board of Technical Education (MSBTE)

  Diploma in Engineering, Electronics and Communication Engineering

  2008 — 2011

• Nagpur University

  BE - Bachelor of Engineering, Electronics and communication engineering

  2011 — 2014