Muhammad Abdul Mutaal

Healthcare Revenue Cycle Management and Credentialing professional with 9+ years of progressive experience across Revenue Cycle Management, provider credentialing and re-credentialing, payer contracting, A/R, claims, denial management, insurance verification and healthcare operations. Currently managing RCM and credentialing activities for healthcare practices, with experience spanning Medical, Mental Health, Dental and Laboratory practices. Strong working knowledge of CAQH, PECOS, MAC and payer portals including NGX, First Coast, Palmetto GBA and Availity.

Experienced in claims auditing, denial and appeal resolution, payer follow-up, client relationship management, operational reporting, ROI analysis and cross-functional coordination.

RCM and Credentialing Manager at RCM Solutions (2024-10 – Present)

Manage provider credentialing, re-credentialing, payer activities, and RCM operations while supporting compliance, reporting, claims oversight, and client service requirements.

• Oversee provider credentialing and re-credentialing workflows, including application follow-up, documentation review, status monitoring, and payer-specific requirements.
• Manage RCM operations covering invoicing, reporting, claims monitoring, issue resolution, and operational follow-up.
• Monitor credentialing and RCM workflows to identify process gaps, outstanding issues, operational delays, and opportunities for improvement.
• Establish and manage provider access across 4 payer and MAC portals, including NGX, First Coast, Palmetto GBA, and Availity.
• Prepare daily RCM reports to monitor operational activity, identify exceptions, track outstanding issues, and support management decisions.
• Conduct weekly audits of submitted claims to identify processing barriers, payer issues, denial patterns, and opportunities to improve collection.
• Analyze operational issues and coordinate with relevant stakeholders to determine root causes and support timely resolution.
• Prepare Return on Investment reports to support resource planning and recruitment decisions for new healthcare practices.
• Manage credentialing and contracting activities across 4 practice areas: Medical, Mental Health, Dental, and Laboratory.
• Coordinate billing, credentialing, payer, and client-facing activities to support end-to-end service delivery.

RCM Lead and Credentialing Executive at Smart Billing Solution (2020-08 – 2024-09)

Led RCM & credentialing activities while supporting client account management, payer communication, provider contracting, business development, and operational problem-solving.

• Led day-to-day RCM and credentialing activities while coordinating priorities across client, billing, payer, and operational stakeholders.
• Managed client accounts throughout the service lifecycle, including service coordination, contract execution, customer support, issue resolution.
• Developed action plans around key clients, target accounts, priority service lines and business development opportunities.
• Built and maintained strong client relationships through structured communication, issue follow-up and responsive service management.
• Analyzed operational and client issues to identify root causes, determine appropriate actions and support resolution of complex account problems.
• Guided clients on CAQH and PECOS requirements to support provider credentialing and enrollment activities.
• Managed credentialing and contracting activities for Medical and Mental Health practices.
• Coordinated communication among clients, billing teams, patients and insurance carriers to resolve operational and payer-related issues.
• Identified potential institutions and market segments to support expansion of RCM and credentialing services.
• Partnered with account executives on new account development, client requirements, service opportunities and product demonstrations.

Account Receivables Specialist at Cure MD (2019-03 – 2020-07)

Supported A/R and medical claims operations with responsibility for claims processing, eligibility, benefits verification, payer follow-up, denial-related activities and HIPAA-compliant documentation.

• Processed high volumes of medical claims while maintaining accuracy in patient, provider and service information.
• Reviewed claims to identify errors, missing information, processing issues and factors affecting auto-adjudication.
• Analyzed payer plans, eligibility requirements and benefits to support accurate claims assessment and reimbursement processing.
• Followed up with insurance companies to verify policy information, payment benefits, claim status and payer requirements.
• Investigated denied and payment-related claims and supported appropriate resolution based on payer and claims processing requirements.
• Identified missing clinical and administrative information and coordinated requests for required documentation.
• Maintained accurate account documentation and file notes across 3 healthcare systems: ECW, Cure Cloud and Athena.
• Applied knowledge of HIPAA requirements, medical terminology, claims processing, payer policies and healthcare billing procedures.
• Supported A/R activities by maintaining accurate claim information and following up on outstanding payer-related matters.

Authorization Specialist at MD Tech (2017-02 – 2019-03)

Supported insurance verification, pre-certification, pre-authorization, patient information management and medical documentation processes.

• Managed insurance verification, pre-certification and pre-authorization activities to support timely patient service delivery.
• Maintained accurate and secure patient information and medical records in accordance with established procedures.
• Coordinated patient messages and information between patients and physicians to support timely communication.

BBA in Management – Superior University, Lahore (2016)