Navjoth A

Senior Associate with over 4+ years of experience in U.S. healthcare provider credentialing. Expert in Primary Source Verification (PSV), credentialing audits, and regulatory compliance. Proven track record of managing end-to-end credentialing for physicians and allied health professionals while maintaining high accuracy and meeting strict Turnaround Times (TATs). Experienced in NCQA and CMS standards within fast-paced, cross-functional environments.

Senior Associate – Provider Credentialing - Sutherland Healthcare Solutions - Hyderabad, Telangana

(2021-01)

• Credentialing Operations: Manage end-to-end credentialing and re-credentialing for U.S. healthcare providers.
• Verification Standards: Perform PSV for licensure, education, board certification, DEA, and malpractice history.
• Compliance & Auditing: Audit files for completeness and accuracy to ensure 100% compliance with NCQA and CMS guidelines.
• Risk Analysis: Review malpractice cases and collaborate with internal committees for network participation decisions.
• Performance Metrics: Consistently meet defined TAT and service quality benchmarks.
• Audit Readiness: Maintain rigorous documentation standards to support organizational audit readiness.

Bachelor of Business Administration - BBA - Sun International Institute for Tourism and Management (2021-07)