Nithyaselvaraj R

Results-driven Healthcare Operations professional with over 15 years of expertise specializing in provider enrollment, credentialing, and medical billing support. Proven track record of leading operational teams, managing end-to-end enrollment workflows, and maintaining strict compliance with insurance carrier guidelines. Adept at navigating complex payer requirements, managing high-level stakeholder escalations, and driving process improvement initiatives to optimize turnaround times and team productivity.

Team Leader - AGS Health

(2024-04)

• Lead and mentor a team of healthcare operations professionals, driving daily performance metrics, quality standards, and SLA compliance.
• Act as the primary escalation point for complex provider enrollment and reimbursement-related roadblocks, interfacing directly with clients and payers to ensure rapid resolution.
• Monitor team productivity, balance resource allocation, and implement strategic workflows to optimize credentialing turnaround times (TAT).
• Deliver regular performance reports, quality insights, and training sessions to foster continuous professional development within the team.

Process Analyst (Level 2) - AGS Health

(2021-06 - 2024-04)

• Spearheaded end-to-end provider enrollment and credentialing workflows, ensuring 100% alignment with diverse insurance carrier and payer requirements.
• Proactively monitored application statuses and executed rigorous follow-up activities to drastically reduce credentialing turnaround times.
• Collaborated directly with providers, medical staff offices, and payers to efficiently resolve complex enrollment and reimbursement-related issues.
• Analyzed existing workflows to identify bottlenecks, driving process improvement initiatives that enhanced overall team productivity and accuracy.

Senior Executive - Miramed Ajuba Solutions Pvt. Ltd.

(2019-07 - 2021-06)

• Managed primary source verification, credentialing data tracking, and direct communications with major healthcare payers.
• Maintained meticulous provider records, ensuring high data accuracy and absolute compliance with industry documentation standards.
• Acted as a key point of contact for resolving administrative escalations between healthcare networks and insurance companies.

Senior Executive - Ajuba Solutions Pvt. Ltd.

(2011-03 - 2018-11)

• Supervised administrative operations for the credentialing cycle, executing timely re-credentialing to prevent lapses in provider billing status.
• Coordinated effectively with internal operational teams and external stakeholders to streamline data collection and validation.

Process Associate - Firstsource Solutions Pvt. Ltd.

(2010-01 - 2011-08)

• Supported foundational healthcare backend operations, managing high-volume data entry and document auditing for medical billing and enrollment workflows.

Bachelor of Commerce - B.Com. - D.B. Jain College (2010)

Higher Secondary Course - HSC - Arignar Anna Higher Secondary School (2007)

Secondary School Leaving Certificate - SSLC - Olcott Memorial High School (2005)