Grishma Hemant Khairnar
Lead Associate – Healthcare Insurance Process
Profile summary
Healthcare Insurance Professional with over six years of experience in insurance verification, claims processing, medical coding support, and revenue cycle operations. Experienced in coordinating with healthcare teams for accurate documentation, claim submission, and payer compliance, with a focus on denial prevention, eligibility verification, and process improvement. Dedicated to ensuring efficient and compliant healthcare revenue cycles.
Career highlights
Scaled Process Quality to 98%: [Healthcare Operations]: Improved quality scores from 50% to over 98% by leading a team through regular monitoring and performance feedback.
Increased Processing Efficiency by 50%: [Process Improvement]: Increased healthcare insurance workflow efficiency by 50%, maintaining accuracy above 99%.
Three-Time Process Improvement Awardee: [Awards]: Recognized with the Top Tier League of Championship for Process Improvement in 2022, 2023, and 2024.
Key skills
Professional experience
The role involved overseeing healthcare operations and insurance coordination. Key responsibilities included managing coding, verification processes, and quality management within these areas.
- Led a healthcare operations team and improved quality scores from around 50% to over 98% through regular monitoring and feedback
- Trained and onboarded 7 new associates, enabling them to achieve 95% quality compliance within 15 days
- Monitored KPIs and turnaround time, improving processing efficiency by 50% while maintaining high accuracy levels
- Performed quality checks on claims, helping maintain >99% accuracy and reducing claim rejections
- Performed Root Cause Analysis (RCA) on audit findings and implemented process improvements to reduce recurring errors
Responsible for reviewing patient medical records and documentation to support accurate medical coding and insurance claim processing.
- Verified patient insurance eligibility and policy details before claim submission to ensure correct information
- Prepared and checked insurance claim documentation according to payer guidelines to avoid processing errors
- Maintained high accuracy in claim processing, helping reduce claim rejections and delays
- Coordinated with internal teams to resolve documentation issues and insurance queries
Developed digital marketing content across various formats, including blogs, newsletters, case studies, and infographics.
- Delivered client-focused content aligned with business and branding goals
Responsible for conducting product demonstrations and reviewing medical records to ensure coding compliance.
- Conducted product demonstrations for U.S. physicians and healthcare practices
- Ensured HIPAA compliance and data privacy
- Reviewed medical records and assigned accurate ICD, CPT, and HCPCS codes