Harish Kumar KulkarnI
Hyderabad
Summary
CPC certified healthcare professional with over 8 years of experience in US healthcare. Skilled at building positive relationships with clients and team members through a warm and supportive approach. Proficient in navigating complex healthcare systems and regulations to ensure high-quality care and patient satisfaction. Successful history of managing caseloads and collaborating with interdisciplinary teams to achieve optimal patient outcomes. Strong communication skills and a dedication to providing compassionate care make me a valuable asset in any healthcare setting.
Overview
10
10
years of professional experience
6036
6036
years of post-secondary education
1
1
Certification
3
3
Languages
Work History
TEAM LEAD
AMPS HEALTHCARE PVT LTD
Hyderabad
09.2023 - Current
- Leading and mentoring the team as a Team leader, allocating work on daily basis, Conducting Staff Meetings to delegate tasks, assign workloads and communicating changing priorities.
- Closely monitored team performance by conducting observations and tracking key metrics, identifying and managing under achievers appropriately.
- Conducting monthly assessments for the team, giving suggestions, and providing proper feedback to the team.
- Identify areas for improvement and implement strategies to enhance patient care and operational efficiency.
- Conduct performance evaluations and provide constructive feedback.
- Promoted a positive work environment by fostering teamwork, open communication, and employee recognition initiatives.
- Enhanced overall team performance by providing regular coaching, feedback, and skill development opportunities.
- Trained new team members by relaying information on company procedures and safety requirements.
SR. ASSOCIATE
AMPS HEALTHCARE PVT LTD
Hyderabad
11.2020 - 09.2023
- Worked on Appeals process.
- Review and analyze US healthcare claims; apply industry standards and coding practices
- Streamlined operational efficiency by identifying areas for improvement and proposing actionable solutions.
- Claims Adjudication on Provider Claims, Repricing the claims using applications Zoho, Dragon, Cobblestone.
- Worked on Denial coding ensuring compliance with coding guidelines.
- Provide support to the Billing team by assigning CPT codes to the received bills and resolving coding-related discrepancies.
- Worked on Legal contracts by providing benefits to clients.
- Worked on Health edge VPN to pull on files and work on them based on Client requirements.
- Analyze claim line items and validate billed charges against contracted fee schedules, Medicare rates, or reference-based pricing models.
- Participated in weekly onshore-offshore coordination calls to discuss project updates, resolve claim issues, and align on repricing or audit priorities.
- Analyzes, evaluates and resolves provider appeals, disputes, grievances, and/or complaints from health plan members, providers and related outside agencies in accordance with the standards and requirements established by the Centers for Medicare and Medicaid and/or Health Plans. Prepares and organizes case research, notes, and documents. Requests, obtain and review medical records, notes, and/or detailed bills as appropriate. Applies contract language, Permitted Payments level, Adverse benefits, and review of covered services.
SR. CONFIGURATION ANALYST
COTIVITI HEALTHCARE PVT LTD
Hyderabad
12.2015 - 07.2019
- Client Management and Adjudication Provide support and training to users on system functionalities and policy configurations.
- Configure healthcare policy rules for US payers by processing Rule Maintenance Requests (RMRs), table loads, and client “switches” before monthly configuration cut-off dates
- Maintain CDM (Clinical Data Model) knowledge, manage name-set tables, CCI deviations, and complex unit/coding configurations as part of monthly updates
- Configure and manage policies within the Cotiviti platform based on business requirements.
- Handling the projects to reduce revenue towards payors by using Applications like RMI, Lotus Notes, Jira, JBPM, etc.
- Develop test scenarios to thoroughly assess medical policies Using Brat Application.
- Assist with research requests and Work on pre and post-test results of client files.
- Analyzed and implemented Correct Coding Initiative (CCI) edits, ensuring compliance with CMS bundling and unbundling rules during claims adjudication.
- Analyze and troubleshoot results, determine root causes, and suggest solutions.
- Ensured alignment of CCI/OCE logic with payer-specific guidelines and Medicare coding policies, improving first-pass claim accuracy.
- Analyze trends, research patterns and anomalies, and identify overpayments both before and after claims are paid.
- Analyze claims in case of rejections and ensure deliverables adhere to Quality standards.
- Ensure policies are correctly implemented and functional within the system.
- Review the work order follow-up with insurance carriers for claim status.
- Worked on Project request received from clients.
- Created and maintained thorough quality management system.
- Work closely with healthcare providers, payers, and internal teams together requirements and provide system solutions.
- Stay updated with industry trends and advancements in healthcare analytics and policy management.
Education
Bachelor of Pharmacy -
BHASKAR PHARMACY COLLEGE
Hyderabad, TG2015
11th And12th - biology, physics and chemistry
SRI CHAITANYA JR COLLEGE
Hyderabad, TG2011
Higher education with SSC background -
SRI VANI HIGH SCHOOL
Sangareddy2009
Skills
- Medical coding
- Medical Terminology
- Denial Management
- Client Management
- MS Office Tools
- Microsoft Excel
- Process Improvement
- Team building coordination
- Leadership influence
- Stakeholder Management
- Client communication
Certification
CPC Certified Medical Coder, AAPC, 02062524
Interests
Would like to watch and play cricket
Interested in Travelling
Software
Cobblestone
ZOHO
Rule Maintaince Interface
Brat
Disclaimer
I SOLEMNLY DECLARE THAT ALL THE PARTICULARS PROVIDED ABOVE ARE TRUE AND CORRECT
Timeline
TEAM LEAD
AMPS HEALTHCARE PVT LTD
09.2023 - Current
SR. ASSOCIATE
AMPS HEALTHCARE PVT LTD
11.2020 - 09.2023
SR. CONFIGURATION ANALYST
COTIVITI HEALTHCARE PVT LTD
12.2015 - 07.2019
Bachelor of Pharmacy -
BHASKAR PHARMACY COLLEGE
11th And12th - biology, physics and chemistry
SRI CHAITANYA JR COLLEGE
Higher education with SSC background -
SRI VANI HIGH SCHOOL
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