Navin Kumar

Detail-driven Healthcare RCM professional with foundational experience as an AR Caller Intern, specializing in DME, complex denials, and appeals. Leveraging expertise in clearinghouses to transition into a Quality Control Analyst (QCA) role. Proven track record in auditing technical billing accuracy adaptable to changing needs, and committed to delivering reliable results. Known for precision, problem-solving abilities, and effective communication skills.

Quality Control Analyst at Healthcare Informatics Pvt Ltd (2025-07 – 2026-05)

• Conducted routine quality assessments to ensure compliance with regulatory standards.
• Maintained detailed records of inspections, tests, and corrective actions taken.
• Conducted root cause analysis for recurring issues, developing long-term solutions to prevent recurrence.
• Provided training to new hires on quality control procedures, fostering a culture of excellence within the team.
• Improved overall production efficiency by identifying and resolving quality control issues.

Senior Executive/Quality Control Analyst at Omega Healthcare Management Services Private Ltd (2022-03 – 2025-01)

• Track daily, weekly, and monthly quality trends to report to operations management, Call Monitoring and Evaluation
• Conduct one-on-one feedback sessions to help agents understand their performance gaps
• Created detailed reports on quality trends, providing insights for executive decision-making processes.
• Established key performance indicators to measure effectiveness of quality control initiatives.
• Enforce HIPAA compliance to protect patient Health Insurance Portability and Accountability Act standards.

Senior Client Partner at Access Healthcare Services Pvt Ltd (2020-10 – 2022-03)

• Validated and processed DME orders, ensuring precise documentation of certificates of medical necessity (CMN) and prescriber orders.
• Drafted and submitted Level 1 appeal/Reconsiderations letters, backed by medical necessity documentation, clinical notes, and proof of prior authorization
• Maintained an average daily call volume of 30+ Conversation with insurance representatives while maintaining a 95%+ quality score.
• Analyzed and resolved complex claim denials. Reduced aging AR buckets (greater than 90 days)

Senior Executive at Omega Healthcare Management Services Pvt Ltd (2020-02 – 2020-10)

• Self-motivated, with a strong sense of personal responsibility.
• Worked effectively in fast-paced environments.
• Skilled at working independently and collaboratively in a team environment.
• Proven ability to learn quickly and adapt to new situations.
• Demonstrated respect, friendliness, and willingness to help wherever needed.

Intern at Global Healthcare Resource (2019-04 – 2020-02)

• Mastered US Healthcare RCM fundamentals, including the life cycle of a claim, provider-patient-payer relationships, and basic medical billing terminology.
• Insurance Follow-up & Operations, Maintained a high accuracy rate in data entry while documenting claim statuses, minimizing errors in internal tracking sheets
• Organized and prepared supporting documentation, such as medical records and prior authorizations, required for the submission of clean claims and appeals.

Diploma in Mechanical Engineering – Government Polytechnic - Kolar Gold Fields (2028-01)

High School Diploma – BEML Composite Junior College - Kolar Gold Fields (2010-06)