Bharath Dharmalingam

PIDM – Cigna

• Managed provider creation and maintenance activities through the PIDM workflow system.
• Reviewed and validated provider data, including NPI, TIN, taxonomy codes, specialty, and demographic details.
• Performed duplicate checks to prevent data redundancy and maintain system integrity.
• Created new provider records and updated existing profiles in compliance with internal guidelines.
• Linked providers to appropriate groups, facilities, and practice locations.
• Coordinated with credentialing and contracting teams to support timely provider activation.
• Ensured provider data accuracy to enable correct claims processing and member directory updates.
• Conducted quality checks and resolved data discrepancies to maintain high accuracy levels.
• Met defined turnaround time (TAT) and quality benchmarks while handling high-volume workloads.
• Maintained compliance with HIPAA regulations, internal policies, and audit requirements.

Aetna – Process Associate

• Managed membership account activities for large group plans, including new medical coverage setup and client data validation.
• Transitioned to the small group team, supporting end-to-end membership maintenance processes.
• Generated and handled operational reports to support team performance and management review.
• Performed quality monitoring with a focus on reducing processing errors and improving accuracy.
• Demonstrated strong teamwork and communication skills to resolve complex membership issues effectively.
• Maintained positive client relationships by resolving service-related issues and meeting quality and service standards.

Provider Credentialing Specialist

• Prepared, submitted, and tracked provider enrollment and re-credentialing applications with Medicare, Medicaid, and commercial payers.
• Collected, reviewed, and verified required documentation, including licenses, certifications, and provider credentials.
• Maintained accurate and up-to-date provider records in internal systems and payer portals.
• Monitored enrollment status to prevent lapses in provider billing eligibility.
• Tracked application progress and provided regular status reports to management.
• Ensured compliance with HIPAA, NCQA, and other regulatory requirements.
• Maintained credentialing files and conducted regular audits to ensure accuracy and completeness.