Kiran Kumar

Operations Leader with 16+ years of experience in US Healthcare Revenue Cycle Management, expertise in Credentialing, Medical Coding, HCC Coding and Medical Billing. Strong experience in client management, operational governance, workforce planning, and performance improvement. Proven ability to improve productivity, reduce escalations, maintain HIPAA compliance, and achieve SLA/KPI targets.

Team Lead (Team Manager) - Carelon Global Solutions India LLP

(2023-08 - 2026-07)

US Healthcare – Credentialing (PECOS, CAQH), Medical Coding, and Billing. Team Size 60 employees.

• Client handling and monitoring client updates on a daily basis
• Weekly quality meetings. Review sessions on errors/escalations to deliver error free processing
• Resolving onshore and internal escalations, maintaining productivity and quality, and maintaining the TAT
• Weekly and Monthly review meetings regarding production and quality
• Monthly EWAM (Early Warning Attrition Management)
• Attrition and Shrinkage control. Conducting interviews and hiring process
• Work allocation and mentoring the team to achieve the target goals and improve quality
• Maintaining HIPAA guidelines

Assistant Manager Operations - WNS Global Services

(2020-11 - 2023-04)

US Healthcare – Credentialing (PECOS, CAQH), Medical Coding, and Billing. Team Size 90 associates.

• Resolving onshore and internal escalations, maintaining productivity and quality, and maintaining the TAT
• Weekly and Monthly review meetings regarding production and quality
• Monthly EWS (Early Warning System)
• Attrition and Shrinkage control
• Work allocation and mentoring the team to achieve the target goals and improve quality
• Maintain HIPAA guidelines
• Conducting interviews and hiring process

Team Leader - Zen3 Infosolutions Private Limited

(2019-05 - 2020-03)

US Healthcare – Credentialing (PECOS, CAQH), Medical Billing. Team Size 30 associates.

• Maintained HIPAA guidelines
• Maintained productivity, quality and TAT
• Mentored and guided employees to foster proper completion of assigned duties
• Attrition and Shrinkage control

Editor 1 (SME) - Factset Systems India Private Limited

(2016-04 - 2019-04)

US Healthcare – RCM Medical Coding and Billing (Demographic Entry, Charge Entry, Payment Posting).

• HIPAA guidelines
• Mentored and guided employees to foster proper completion of assigned duties
• Built strong relationships with clients through positive attitude and attentive response
• Conducted training and mentored team members to promote productivity, accuracy and commitment to friendly service
• Random auditing of work done by other QAs

Senior Associate - iMedX Information Services Private Limited

(2009-01 - 2015-09)

US Healthcare - RCM Billing (Demographic Entry, Charge Entry, Payment Posting).

• Following HIPAA guidelines
• Maintaining accuracy at all levels in processing and meeting monthly production target

MBA - International Business - ISBM (Indian School of Business Management and Administration) (2009-07)

M.Sc.

• Microbiology - J.J. College of Arts and Science (Bharathidasan University, Pudukkottai, Tamilnadu) (2004)

B.Sc.

• Microbiology - Aurora Degree College (Kakatiya University, Warangal, A.P) (2002)

Intermediate - Baby Moon Cooperative Junior College, Khammam (1999)

Class X - S. C. High School, Mancherial (1996)