Sankalpa Menikpura
Ragama,1
Summary
Results-oriented professional with ten years of experience in Healthcare Revenue Cycle Management operations. Adept at streamlining all aspects of RCM, including account receivables, claims processing, and denial management, while maintaining adherence to HIPAA, Medicare, and Medicaid rules. a track record of improving financial performance, streamlining processes, and increasing operational efficiency. Dedicated to providing excellence in healthcare operations and fostering organizational growth.
Overview
10
10
years of professional experience
Work History
Assistant Team Lead
HealthRecon Connect (pvt)Ltd.
Colombo
01.2023 - 06.2024
- Assisted the Manager in overseeing the denial management process, ensuring timely and accurate resolution of denied claims to optimize reimbursements and minimize revenue loss
- Collaborated with team members to implement effective denial management strategies, improve workflow efficiency, and drive continuous process enhancements
- Ensured adherence to payer regulations and organizational standards while fostering a productive and goal-oriented team environment, contributing to the achievement of operational and financial objectives
- Generate regular and ad-hoc reports to present key performance indicators (KPIs) to management and department heads
- Ensured adherence to healthcare regulations, payer requirements, and industry standards (e.g., HIPAA, Medicare, Medicaid)
- Streamlined denial management processes by identifying bottlenecks and implementing solutions to improve workflows, reduce claim denials, and accelerate reimbursements
- Developed and documented standard operating procedures (SOPs) for billing and denial management to ensure consistency and compliance
- Coordinated with cross-functional teams, including billing and coding to ensure alignment on revenue cycle objectives
- Mentored and trained junior analysts on billing, denial management, operational workflows, and industry best practices
- Develop strategies to address claim denials, analyze root causes, and implement corrective actions to minimize future occurrences
- Conduct or oversee internal audits of billing and coding practices to ensure accuracy and compliance
- Supervised 20+ co-workers.
Operations Specialist
HealthRecon Connect (pvt)Ltd.
Colombo
10.2016 - 12.2022
- Responsible for verifying patient insurance information, ensuring proper coding of diagnoses and procedures, and accurately processing and submitting insurance claims
- Also involves maintaining up-to-date knowledge of healthcare regulations, payer policies, and billing codes to ensure compliance and minimize billing errors
- Verified patient insurance coverage and eligibility
- Ensured correct insurance information was recorded to avoid claim denials
- Prepared and submitted accurate insurance claims to payers, ensuring compliance with healthcare regulations
- Ensured proper use of medical codes (ICD-10, CPT, HCPCS) for procedures and diagnoses
- Generated reports on billing performance metrics for internal use and audits
- Mentored and trained junior analysts on billing, operational workflows, and industry best practices
- Oversaw day-to-day operations, delegating tasks appropriately to ensure smooth workflow and timely completion of projects.
- Boosted customer satisfaction, addressing client concerns in a timely and professional manner.
- Successfully managed multiple projects simultaneously while adhering to deadlines and budget constraints.
- Continuously sought opportunities for professional development in order to remain knowledgeable about industry best practices.
- Provided training for new hires, fostering a supportive learning environment conducive to success in their roles.
- Collaborated across departments to identify opportunities for process improvements and increased efficiency.
Medical Account Executive
MediGain (pvt)Ltd.
Colombo
06.2014 - 02.2016
- Responsible for accurately recording payments and adjustments to patient accounts
- Ensures the financial integrity of the revenue cycle by managing incoming payments from insurance companies, government payers, and patients
- Accurately posting payments, denials, and adjustments from Explanation of Benefits (EOBs), Electronic Remittance Advice (ERA), and other payment sources
- Reconciling daily deposits with payment records to ensure accuracy and identify discrepancies
- Identifying underpayments, over payments, and incorrect adjustments; flagging issues for further resolution
- Ensuring patient accounts reflect accurate financial information, including co-payments, deductibles, and balances
- Working closely with billing teams and denial management teams, to resolve discrepancies and support follow-ups on outstanding claims
- Handling high-level client communication - posting related queries or requests
- Conducting posting Audits
- Adhering to HIPAA regulations and organizational policies when handling sensitive financial and patient information
- Training new and junior Medical Account Executives
- Maintaining and updating SOPs
- Coordinating with supervisors and leads/collection individuals in order to resolve issues
- Proactively managed client correspondence and recorded tracking and communications.
Education
Bachelor of Arts - Business
University of The West of Scotland
Glasgow, Scotland04.2023
Skills
Revenue Cycle Management
Medical Billing
Denial Management
Payment Posting
Medical Coding (CPT/ICD-10)
Client Onboarding
MS Office
Communication
Problem Solving
Team Work
Timeline
Assistant Team Lead
HealthRecon Connect (pvt)Ltd.
01.2023 - 06.2024
Operations Specialist
HealthRecon Connect (pvt)Ltd.
10.2016 - 12.2022
Medical Account Executive
MediGain (pvt)Ltd.
06.2014 - 02.2016
Bachelor of Arts - Business
University of The West of Scotland
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