Pushpanjali V

Credentialing and provider enrollment leader with 8+ years of progressive US healthcare experience, specializing in end-to-end credentialing operations, payer enrollment, and regulatory compliance. Proven success in building and scaling teams, driving quality and SLA performance, managing direct US client relationships, and maintaining full compliance with NCQA, CMS, and payer requirements. Recognized for handling complex enrollments, audits, escalations, and cross-functional coordination in fast-paced environments.

Supervisor – Credentialing - Business Integrity Services (BIS) - Chennai, India

(2020-12)

Lead end-to-end credentialing and provider enrollment operations for US healthcare clients, including initial credentialing, re-credentialing, renewals, and ongoing monitoring.

• Manage, mentor, and develop a team of 10+ credentialing professionals across Specialist, QA, and Team Lead roles.
• Serve as the primary point of contact for US clients, delivering weekly and monthly performance reports, SLA reviews, and escalation management.
• Ensure full compliance with NCQA standards, CMS regulations, and payer-specific guidelines.
• Oversee CAQH profile creation and attestations, PECOS enrollments, NPPES updates, and commercial payer applications.
• Lead provider onboarding and go-live coordination, partnering with billing, operations, and client teams.
• Design, implement, and maintain SOPs, training materials, and quality checklists aligned with regulatory and client updates.
• Conduct quality audits, analyze defect trends, and drive corrective and preventive action plans.
• Track and improve key performance indicators (TAT, productivity, quality, backlog) through structured reporting and targeted coaching.
• Promoted from Credentialing Specialist → QA → Team Lead → Supervisor, reflecting sustained high performance and leadership capability.
• Successfully scaled operations from 2 FTEs to 6+ FTEs while maintaining high quality and client satisfaction.
• Awarded the Golden Award (2021) and multiple Star of the Month and performance recognitions.

AR Caller / Denial Management Specialist - Global Healthcare Executive

(2019-01 - 2020-12)

• Supported credentialing-related denial management and payer follow-ups.
• Identified enrollment and credentialing gaps impacting claim adjudication.
• Coordinated with internal teams to resolve provider eligibility and payer-related issues.

Client Partner – Overpayments - Access Healthcare

(2017-01 - 2018-12)

• Managed payer communications and reconciliations related to overpayments.
• Ensured accurate documentation and adherence to payer compliance standards.
• Strengthened exposure to US payer workflows and client interactions.

Executive – RCM AR Caller - Omega Healthcare

(2016-01 - 2017-12)

• Initiated US healthcare career handling AR follow-ups and payer communications.
• Secured 3rd place in the Omega training program, demonstrating early performance excellence.

B.E. - Computer Science - Aalim Muhammed Salegh College of Engineering (2016-01 - 2016-01)

HSLC - Nazareth Matriculation Higher Secondary School (2012-01 - 2012-01)

SSLC - Nazareth Matriculation Higher Secondary School (2010-01 - 2010-01)