Manish Kumar

Detail-oriented professional with expertise in provider credentialing, accounts receivable calling, and claims management in US healthcare.

Experience includes end-to-end enrollment and re-credentialing for Medicare, Medicaid, and commercial providers, compliance audits, and data integrity management. Skilled in eligibility verification and claims resolution, with strong capabilities in Excel and data analysis. Committed to enhancing operational efficiency and supporting organizational growth.

Provider Credentialing - CARELON GLOBAL SOLUTIONS LLP - Hyderabad, India

(2023-07 - 2026-06)

• Processed over 150 provider enrollment applications monthly for Medicare, Medicaid, and commercial payers, ensuring timely access to services for patients.
• Prepared, reviewed, and submitted CMS-855 Medicare enrollment applications (including 855I, 855B, 855R, and 855O) for individual providers and medical groups.
• Gathered and verified provider information, including credentials, contact details, and specialties, for hospitals in Georgia and Virginia regions, enhancing accuracy of credentialing processes.
• Maintained and updated provider information in CAQH ProView, PECOS, and payer-specific portals to support accurate credentialing and billing.
• Assisted in the re-credentialing and re-enrollment process, ensuring continuous participation and minimizing claim denials due to enrollment issues.
• Synced provider information across various systems to ensure consistency and accuracy across healthcare networks, directories, and claims processing.
• Generated and analyzed reports on provider data to support decision-making, regulatory compliance, and operational efficiency.

AR Caller - Hinduja Global Solutions (HGS) - India

(2021-09 - 2022-10)

• Engaged with customers having outstanding debts, facilitating timely payment collection and improving cash flow.
• Processed payments from customers in a timely manner according to established procedures.
• Analyzed accounts receivable data, ensuring accuracy of patient records and supporting effective billing processes.
• Reviewed and processed over 100 insurance claims daily, achieving a 98% accuracy rate to ensure timely resolution and high client satisfaction.
• Implemented streamlined claims processing methodologies, reducing turnaround time by 20% and boosting overall productivity and cost efficiency.
• Collaborated with cross-functional teams to identify and resolve over 200 recurring claim issues, leading to a 15% decrease in total claims disputes.
• Ensured compliance with HIPAA regulations during all interactions with patients.

Bachelor of Arts - KRANTHI DEGREE COLLEGE (OSMANIA UNIVERSITY) (2021-01)

High School Diploma - Hyderabad, India (2017-01)

High School Diploma - Hyderabad, India (2015-01)