Mohammed Imthiyaz

Results-driven Healthcare Credentialing professional with 9+ years of end-to-end provider credentialing experience, specializing in Aetna provider enrollment, CAQH management, Primary Source Verification (PSV), and team leadership. Proven track record in managing credentialing workflows, SLA compliance, quality governance, and client reporting within US Healthcare RCM environments. Adept at mentoring teams and delivering training to new associates with measurable performance improvements.

Senior Process Executive – Data (Healthcare | Aetna) at Cognizant Technology Solutions (2016-07 – 2026-04)

• Supervised daily credentialing operations, ensuring smooth workflow and adherence to TAT and SLA requirements.
• Monitored team performance across production targets, quality standards, and attendance metrics.
• Provided SME support for credentialing process queries and served as the primary escalation point for complex cases.
• Delivered structured process training to new associates and conducted assessments to evaluate learning progress.
• Prepared and updated training materials to reflect the latest process changes and client requirements.
• Managed end-to-end Aetna provider credentialing for new and re-credentialing cases: application intake, document collection, PSV, and submission within defined turnaround timelines.
• Conducted Primary Source Verification (PSV) for NPI, CAQH, state licenses, DEA, CDS, board certifications, malpractice coverage, and federal/state sanction checks (OIG, SAM, NPDB).
• Updated, reviewed, and maintained CAQH profiles ensuring data accuracy, completeness, attestations, and credentialing readiness prior to Aetna submission.
• Maintained accurate provider data in EPDB, Mainframe (RUMBA), CAQH, and Payer portals, ensuring compliance with Aetna credentialing guidelines and regulatory requirements.
• Coordinated with physicians, practice managers, clinics, and internal teams to obtain missing documents, signatures, licensure copies, malpractice insurance, and compliance forms.
• Performed bi-weekly and ad-hoc follow-ups with Aetna representatives to track application status, resolve discrepancies, and escalate delayed or aging cases.
• Generated and maintained credentialing reports: application tracking logs, follow-up trackers, inventory aging reports, and compliance audit documentation.
• Verified licenses via outbound calls to state boards and managed initial credentialing and re-credentialing within regulatory timelines.
• Tracked and shared attendance reports for the entire project, along with daily and monthly production and quality reports with stakeholders.
• Generated and shared reports from client environment on overall inventory, inflow, resolved files, and aging file status.
• Sent weekly reports on task progress and forecasts to management and client teams.

Bachelor of Computer Applications in Computer Applications – The New College, Chennai (2016)