SHANAKA HARINDRA WIJEWARDANA
Kirulapana,Colombo
Summary
Results-driven healthcare operations professional with over 9 years of experience in Revenue Cycle Management (RCM), denial management, and healthcare operations. Adept in optimizing workflows, leading cross-functional teams, and enhancing claim resolution processes. Proven ability to drive high performance, ensure regulatory compliance (HIPAA, ISO), and foster continuous process improvement. Key strengths include team leadership, denial analysis, AR follow-up, SOP development, FTE planning, and quality assurance. Highly effective in client communication and internal stakeholder coordination to meet operational KPIs and service-level agreements.
Overview
14
14
years of professional experience
Work History
TEAM LEAD - ONLINE COLLECTIONS
Invent HealthMatics Inc.
12.2024 - Current
- Spearheading the Online Collections function by overseeing follow-ups on outstanding claims, reducing Days in AR through proactive payer engagement.
- Led the Quality Assurance (QA) Team, implementing claim audit frameworks and compliance checkpoints aligned with Operational Control Framework (OCF) standards.
RCM SPECIALIST - QA (CSE OUTPUT FILES)
Innobot Health
11.2024 - 12.2024
- Conducted quality audits and supported claims review process improvements.
TEAM LEAD - OPERATIONS
HealthRecon Connect LLC
09.2022 - 10.2024
- Managed end-to-end denial management workflows, improving claim success rate and reimbursement timelines.
- Created SOPs for top denial categories. and trained analysts on appropriate resolution pathways.
- Conducted weekly performance reporting to the management teams, highlighting denial trends, appeal turnaround, and AR aging.
- Implemented internal QA procedures aligned with HIPAA and ISO standards, supporting external audits and compliance checks.
- Led FTE planning, workload forecasting, and capacity monitoring using RCM analytics dashboards.
- Ensured accuracy in claim status, timely escalations, and adherence to payer-specific collection strategies using RCM platforms and clearinghouse tools.
- Designed performance dashboards to track KPIs such as collection rate, denial overturn rate, and claim resolution cycle; regularly reported to senior management.
- Conducted Root Cause Analysis (RCA) on frequently denied claims and integrated QA feedback to improve first-pass resolution rates.
- Mentored QA and collection analysts, standardized SOP adherence, and drove cross-functional training on payer behavior and denial codes.
- Maintained client SLA compliance, 30% paid rate targets, and timely reporting.
ASSISTANT TEAM LEAD - OPERATIONS
HealthRecon Connect LLC
08.2021 - 08.2022
- Supported team supervision, training, and claims resolution across client accounts.
SENIOR CLAIMS ANALYST - DENIAL MANAGEMENT
HealthRecon Connect LLC
04.2019 - 01.2020
- Performed denial reviews and coordinated corrective actions with billing teams.
SENIOR CLAIMS ANALYST - DENIAL MANAGEMENT
RCM MediGain Colombo Pvt Ltd
01.2018 - 04.2019
- Identified patterns in claim rejections and helped streamline processes.
CLAIMS ANALYST - DENIAL MANAGEMENT
RCM MediGain Colombo Pvt Ltd
07.2017 - 01.2018
OPERATIONS EXECUTIVE
Mediccom Pvt Ltd
04.2016 - 07.2017
TEAM ASSISTANT (TA TEAM)
Innodata Inc.
07.2015 - 03.2016
- Overlook team deliverables and administrative coordination.
ASSOCIATE
Innodata Inc.
01.2012 - 07.2015
Education
High School Diploma - Computer Science
University College Dublin
01.2016
General Education - Mathematics
Royal College
01.2012
Skills
- Revenue Cycle Management (RCM)
- Denial Management & Claims Review
- Team Leadership & People Development
- HIPAA & ISO Compliance
- SOP & Workflow Development
- FTE Planning & Resource Allocation
- Client & Internal Communication
- Quality Assurance & Training
- Performance Reporting & KPIs
<Enter your own>
Nationality: Sri Lanka
Timeline
TEAM LEAD - ONLINE COLLECTIONS
Invent HealthMatics Inc.
12.2024 - Current
RCM SPECIALIST - QA (CSE OUTPUT FILES)
Innobot Health
11.2024 - 12.2024
TEAM LEAD - OPERATIONS
HealthRecon Connect LLC
09.2022 - 10.2024
ASSISTANT TEAM LEAD - OPERATIONS
HealthRecon Connect LLC
08.2021 - 08.2022
SENIOR CLAIMS ANALYST - DENIAL MANAGEMENT
HealthRecon Connect LLC
04.2019 - 01.2020
SENIOR CLAIMS ANALYST - DENIAL MANAGEMENT
RCM MediGain Colombo Pvt Ltd
01.2018 - 04.2019
CLAIMS ANALYST - DENIAL MANAGEMENT
RCM MediGain Colombo Pvt Ltd
07.2017 - 01.2018
OPERATIONS EXECUTIVE
Mediccom Pvt Ltd
04.2016 - 07.2017
TEAM ASSISTANT (TA TEAM)
Innodata Inc.
07.2015 - 03.2016
ASSOCIATE
Innodata Inc.
01.2012 - 07.2015
High School Diploma - Computer Science
University College Dublin
General Education - Mathematics
Royal College
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