Vijay Kumar Nagaraju

Accomplished Healthcare RCM Team Lead with over 9 years of experience driving operational excellence in Accounts Receivable (AR), Denials Management, and Prior Authorization. Proven track record of spearheading cross-functional teams of up to 40 FTEs to consistently exceed client SLAs and resolve high-dollar billing disputes. Adept at leveraging Power BI, Excel Macros, and Power Automate to optimize workflows, drastically reducing administrative overhead and maintaining AR 90+ aging strictly under 10%.

Team Lead - ECOSMOS INDIAN PVT LTD

(2025-08)

• Direct daily US Provider and Payer operations across the various departments (Eligibility, AR Follow up, Denials and Prior Authorization).
• Managed 32 FTEs across all aging buckets (30-120+ days); successfully drove down AR 90+ aging to under 10% and overall Denials below 7%.
• Delivered regular KPI reports, Waterfall summaries, and Aging Summary metrics to senior leadership to guide strategic resource allocations.
• Managed client escalations regarding high-dollar patient billing disputes, answering queries directly via email to optimize resolutions.
• Coordinate with team members to resolve complex issues related to denials, prior authorization, and eligibility and benefits workflows.
• Programmed Excel Macros and Power Automate workflows to generate daily trend insights, decreasing administrative overhead.
• Monitor core operational parameters including Inbound Call Performance, AHT, Hold Time, and Daily Interval Volumes.
• Led weekly denial trend syncs to introduce correctives, and spearheaded regular standard operating procedure (SOP) evaluations.
• Conduct monthly performance appraisals and pipeline mapping to smoothly manage intra-day queues and process health.

Delivery Lead - OMEGA HEALTHCARE MANAGEMENT SERVICES

(2024-10 - 2025-05)

• Directly supervised 40 FTEs, guaranteeing timely clearance of seasonal Eligibility and Benefits project pipelines.
• Tracked daily capacity utilizing ProHance (TMS) software, resulting in optimal workforce scaling with zero team attrition.
• Standardized cross-shift Handover Reports to reduce processing delays and maximize client contractual compliance.
• Organized knowledge assessment programs to validate team baseline process capabilities and identify individual coaching paths.
• Implemented Macros to automate specific reports and ensure smooth operational flow.

Quality Controller / Sr. Process Associate - AVAILITY INDIA PVT. LTD.

(2019-01 - 2024-12)

• Handled operational auditing for a team of 20 FTEs working on complex claim rejections, denials management, and EDI enrollment configurations.
• Partnered with internal development squads to prototype data validation models and implement efficient tools, boosting team-wide production accuracy.
• Tracked critical aged claim queues, personally monitored up to 120 calls daily across multiple lines of business, and maintained seamless operations in the absence of Quality Analysts.
• Spearheaded a process optimization initiative that reduced call management time, directly improving efficiency and customer satisfaction.
• Outlined and executed a comprehensive training program for newly onboarded associates, significantly raising day-30 first-call resolution (FCR) levels and team performance.

Senior Accounts Receivable Executive - VEE TECHNOLOGIES PVT. LTD.

(2017-01 - 2019-12)

• Guided a pod of 3 FTEs focusing on complex payer rejections, denial management, and targeted patient outreach accounts.
• Monitored the initial output of new associates and provided tailored phone etiquette and tactical negotiation training.
• Optimized specific insurance clearinghouse rules to minimize the turnaround times on recurring re-billing cycles.

Executive – RCM (AR) - OMEGA HEALTHCARE MANAGEMENT SERVICES

(2015-01 - 2016-12)

• Led a microteam of 4 FTEs to maintain full compliance, achieving a 100% data processing quality rating within 6 months.
• Provided tactical walk-throughs and real-time guidance to newer associates struggling with complex claim adjudications.

B.Com. - Secretarial Practice - Sheshadripuram Evening Degree College, Bengaluru (2014)