Hello! I'm Piyush Pandey
I’ve spent more than three years working right in the thick of US Healthcare Revenue Cycle Management. Most of my days revolve around insurance verification, medical billing, and wrangling with denials and rejections—whether it’s commercial or government payers, I’ve seen it all.
I dig into claim denials, figure out what’s going wrong, and jump in to fix things fast. I’m hands-on with everything from checking patient eligibility, breaking down benefits, reviewing claims before they go out, and keeping the conversation going with payers to get claims paid.
On top of the day-to-day, I’ve gotten pretty sharp at spotting patterns and trends in the data—why claims get denied, how payers behave, and where our own processes trip up. I lean on tools like Power BI and Excel to pull the numbers together, slice and dice the data, and lay it out so everyone can see what’s working (and what’s not). That way, we make smarter decisions and keep things running smoother.
I’m used to working with strict SLAs, making sure every box is checked for quality and compliance, and teaming up across departments to hit our goals. Plus, with a background in Lean Six Sigma, I love finding ways to cut out the waste and help the team do things better, one process at a time.


Piyush Pandey
PORTFOLIO
+91 91963226683
Email:
Address:
Vivekananda nagar Colony Podrah
Howrah, 711109
Date of Birth:
June 06th 1999
Phone:
EXPERIENCE
09/2023 - Till Now
Program Specialist
Neovance
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Engineered Tableau dashboards and performance reports driving data-driven decisions for senior stakeholders
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Optimized claims processes across major US insurers, reducing errors by 25% through system audits .
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Analyzed revenue cycle bottlenecks, implementing Solution and enhancing overall performance and claim resolution.
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Ensured 100% alignment with evolving payer regulations through Payer Specific industry intelligence monitoring
03/2023 - 08-2023
Senior Process Associate
Sun Knowledge Services Inc.
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Achieved 95%+ on accuracy conducting insurance payment on across multi-payer systems.
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Reduced processing delays by 30% through cross-functional Collaboration on and advanced data analysis.
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Led training for 8+ new hires, accelerating onboarding and enhancing operational excellence.
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Resolved 50+ process gaps monthly through systema c audits ensuring compliant claims processing
03/2022 - 02/2023
Sun Knowledge Services Inc.
Process Associate
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Maintained 98% accuracy in claims processing across UHC, Cigna, Aetna, BCBS, and Tricare payer systems.|
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Improved workflow efficiency by 25% through system insurance procedure data analysis.
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Maximized cash flow executing strategic AR follow-ups and unpaid claims tracking
03/2022 - 02/2023
Team Lead
Kaash Infotech Pvt Ltd.
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Spearheaded AR challenge Resolution, improving efficiency and financial Operations.
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Reduced manual error by 35% implementing process automation in collaboration on with senior management.
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Enforced HIPAA standards ensuring data integrity while maintaining operational efficiency.
03/2022 - 02/2023
Customer Service Specialist
Kaash Infotech Pvt Ltd.
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Customer Excellence: Delivered exceptional customer support consistently exceeding client expectations, maintaining 95%+ customer satisfaction scores
•Strategic Problem-Solving: Proactively developed and recommended innovative strategies to enhance customer satisfaction and resolve complex service inquiries
•Communication Leadership: Served as prithe mary communication hub for team coordination, effectively disseminating critical information and ensuring seamless operations
EDUCATION
2022 - 2024
Masters of Computer Application
Amity University
Focused on computer applications, data analysis, and problem-solving, building strong technical and analytical capabilities.
2017 - 2022
Bachelor of Commerce
Calcutta University
Developed a solid foundation in accounting, finance, and business fundamentals with a strong analytical mindset.
CERTIFICATIONS




SKILLS

Advance MS Office Suite
Customer Service Excellence
Analytical Thinking
Lean managment
Power BI
DAX and SAP
Claims Processing
HIPAA Regulations
State-Specific Insurance Regulations
Deadline Prioritization
PROJECTS
• Identified top denial reasons impacting reimbursement
• Analyzed payer-wise and denial-code-wise trends
• Highlighted opportunities for operational improvement


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Analyze overall Medicare Part B drug spending
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Identify top drugs driving total cost
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Compare high-volume vs high-cost drugs
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Highlight drugs with extreme per-beneficiary costs
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Provide actionable insights and recommendations





