Muhammad Tufail
Medical Manager/RCM Senior Specialist
Mardan,KPK
Overview
13
13
years of professional experience
1
1
Certification
Work History
RCM SENIOR SPECIALIST (QUALITY LEAD)
CUBE HEALTHCARE SYSTEMS PVT. LTD.
01.2023 - Current
- Implementing and enforcing quality assurance policies and procedures
- Establishing and monitoring quality metrics and performance indicators
- Conducting regular audits and evaluations to identify areas needing improvement
- Collaborating with cross-functional teams to enhance coding processes
- Ensuring compliance with relevant laws, regulations, and industry standards
- Fostering a culture of quality and compliance throughout the organization in collaboration with other departments
- Assessing billers' performance and providing on-the-job training programs
- Continuously optimizing processes and evaluating performance through robust reporting mechanisms
- Ensuring users and practices meet established quality benchmarks and MGMA standards
- Maintaining consistency in performance across all team members and practices to achieve KPIs
- Familiarity with EPM, EHR, Clearing Houses, DMA, HL7 Integration, and healthcare provider portals
- Examined key performance indicators (KPIs) in Medical Billing, such as Denial Rate, Days in AR, Payer Mix, etc., utilizing reporting methods aligned with industry benchmarks.
ASSISTANT MANAGER OPS
CUBE HEALTHCARE SYSTEMS
01.2021 - 12.2022
- Manage overall revenue, ensuring timely filing, maximizing billing revenue and collections, and resolving denied/rejected claims
- Monitor reports to ensure clean claim submissions
- Review monthly aging reports, follow up on unpaid claims, and take corrective actions for reimbursement
- Develop, implement, and maintain revenue cycle SOPs.
A/R SUPERVISOR
CUBE HEALTHCARE SYSTEMS
10.2018 - 12.2020
- Lead AR team to reduce AR aging and optimize collections
- Oversee the entire medical billing process, ensuring accuracy, timeliness, and regulatory compliance
- Perform quality checks on A/R follow-ups and EOB denial analysis before client submission
- Stay updated with medical billing regulations, coding guidelines, and insurance policies, and train the team accordingly
- Develop processes to improve team productivity and quality
- Monitor and analyze billing data to identify trends, issues, and areas for improvement
- Resolve complex denial issues in Medical, Auto, Pharmacy, and Workers Compensation practices.
TEAM LEAD BILLING
CUBE HEALTHCARE SYSTEMS
01.2017 - 09.2018
- Lead and manage a team of medical billing and revenue cycle professionals
- Ensure accurate and timely processing of medical billing claims
- Monitor and analyze billing and collection metrics to resolve issues
- Develop and implement processes to improve billing and revenue cycle efficiency
- Collaborate with other departments to ensure regulatory compliance
- Provide training and mentorship to team members
- Shared Weekly, Monthly reports with manager in understandable format to be presented in client Meetings.
BILLING EXCUTIVE
CUBE HEALTHCARE SYSTEMS
10.2015 - 12.2016
- Prepare and submit billing data and medical claims to insurance companies
- Ensure patient medical information is accurate and up to date
- Resolve EDI front and back end rejections on daily basis
- Post charges for Medical, Auto, Pharmacy, DME, and Workers Compensation clients
- Verify eligibilities for Medical, Office, Hospital, and Pharmacy benefits
- Work on daily and weekly productivity reports and share with Team Lead.
ACADEMIC AND ADMIN INCHARGE
IQRA SCHOOL & COLLEGE
04.2011 - 09.2015
- Oversee Teacher Training by helping them to build strong instructional skills and deeper understanding of educational tools and technologies available to them
- Supervising students' development by evaluating their progress reports.
Education
B. S in Computer Science (Hons) -
KPK Agricultural University Peshawar
Intermediate (Pre Engineering) HSSC -
Federal Board of Intermediate & Secondary Education Islamabad
Matriculation (Science) SSC -
Board of Intermediate and Secondary Education Peshawar
Skills
- Denial Management
- A/R Followup
- Payment Posting
- Charges Entry
- Adhoc Reporting
- DME, RX, PART B
- Quality Reporting
- Team Management
- Altumed EPM
- Altumed Provider Portal
- Care Cloud
- Care Tracker
- Change Health Care
- Citric Epic
- Collaborate MD
- Speedy Claims CMS-1500
- Health Fusion
- Practiice Fusion
- I Care Link: El Camino Health
- Kareo
Certification
- Certificate of DGL Project
- Certificate of IT Soft Skills
Languages
English, Urdu, Pashto
Native language
Summary
Forward-thinking Senior Specialist equipped with advanced operational and technical knowledge of [Area of expertise]. Proven team leader and problem-solver competent in navigating complex situations. Manages assignments, schedules and projects with organized and detail-oriented mindset.
Timeline
RCM SENIOR SPECIALIST (QUALITY LEAD)
CUBE HEALTHCARE SYSTEMS PVT. LTD.
01.2023 - Current
ASSISTANT MANAGER OPS
CUBE HEALTHCARE SYSTEMS
01.2021 - 12.2022
A/R SUPERVISOR
CUBE HEALTHCARE SYSTEMS
10.2018 - 12.2020
TEAM LEAD BILLING
CUBE HEALTHCARE SYSTEMS
01.2017 - 09.2018
BILLING EXCUTIVE
CUBE HEALTHCARE SYSTEMS
10.2015 - 12.2016
ACADEMIC AND ADMIN INCHARGE
IQRA SCHOOL & COLLEGE
04.2011 - 09.2015
B. S in Computer Science (Hons) -
KPK Agricultural University Peshawar
Intermediate (Pre Engineering) HSSC -
Federal Board of Intermediate & Secondary Education Islamabad
Matriculation (Science) SSC -
Board of Intermediate and Secondary Education Peshawar
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