Imran Hussain

Senior RCM Executive

Medibill MD • Fulltime

Mar 2024 - Jan 2026 • 1 yr 10 mos

At MediBill MD, I was responsible for the full lifecycle of Revenue Cycle Management for high-volume healthcare organizations. My role went beyond standard claim submission; I focused on financial health optimization, payer contract analysis, and sophisticated denial mitigation strategies to ensure maximum practice profitability. Key Responsibilities & Impact: End-to-End RCM Orchestration: Managed the entire "Patient-to-Payment" workflow, including front-end eligibility, mid-cycle coding audits, and back-end AR recovery. I ensured that the synchronization between clinical documentation and financial billing was seamless. Denial Root-Cause Specialist: I developed a proprietary tracking system at MediBill MD to identify "Denial Clusters." By spotting trends in payer rejections (such as specific 2026 AI-driven edits from BlueCross or Aetna), I was able to implement preventive coding measures that reduced the overall denial rate by 28% within the first 6 months. Advanced AR Management: Spearheaded the recovery of aged Accounts Receivable. I specialized in "Hard Denials" and clinical appeals, successfully reclaiming revenue for claims that had been pended for over 120 days. My efforts directly resulted in a 15% increase in monthly net collections for my assigned providers. Audit & Compliance Leadership: Conducted comprehensive "Shadow Audits" to ensure all claims met the 2026 CMS-1500 and UB-04 requirements. I maintained a 99% accuracy rate in ICD-10-CM and CPT code assignment, protecting practices from potential RAC audits and compliance penalties. Platform Expert: Utilized high-level functions within Kareo, AthenaOne, and eClinicalWorks (eCW) to automate repetitive tasks, such as ERA posting and secondary claim crossovers, which increased departmental efficiency by 35%. Core Competencies Developed: Payer Performance Tracking High-Dollar Clinical Appeals MIPS/MACRA Reporting Support 2026 Regulatory Compliance

Senior Billing Executive

Physician Revenue Group, Inc • Fulltime

Feb 2020 - Feb 2024 • 4 yrs

Senior Billing Executive: Revenue Cycle & Compliance Specialist As a Senior Billing Executive, I spearheaded the end-to-end Revenue Cycle Management (RCM) operations for diverse healthcare providers, ranging from solo practices to large multi-specialty clinics. My primary focus was on optimizing financial performance, ensuring 100% HIPAA compliance, and maintaining a stagnant-free cash flow in an increasingly complex payer environment. Key Responsibilities & Achievements: Strategic Denial Management: I led a dedicated "Recovery Task Force" that focused on high-dollar aged AR. By implementing a root-cause analysis protocol, I successfully overturned 85% of clinical denials related to medical necessity and experimental procedures. I personally drafted customized appeal letters that recovered over $150,000 in previously "uncollectible" revenue. Precision Coding & Auditing: Utilizing the latest ICD-10-CM, CPT, and HCPCS coding sets, I performed weekly internal audits. This proactive approach ensured a 98% Clean Claim Rate (CCR) on first-pass submissions, significantly reducing the "Days in AR" (Average Days: 22-26). Workflow Optimization: I specialized in the deep-level configuration of EHR/EMR platforms, including Kareo, AthenaHealth, and eClinicalWorks. I optimized these systems to include real-time eligibility verification and automated claim scrubbing, which reduced front-desk administrative errors by 40%. Payer Relations & Contracting: I acted as the primary liaison between the practice and major insurance carriers (Medicare, Medicaid, UnitedHealthcare, BCBS, and Aetna). My role involved staying ahead of AI-driven payer filters and policy changes to ensure the practice remained credentialed and properly reimbursed. Financial Reporting: Provided monthly "Financial Health Summaries" to stakeholders, tracking Key Performance Indicators (KPIs) such as Net Collection Ratio, Bad Debt Percentage, and Payer Mix analysis.