Deepak Pandey

After one year, the company promoted me as a client service manager.

I was responsible for overseeing the new credentialing and recredentialing of all providers across the floor for Medicare, Medicaid, commercial, and Medicaid MCO plans, Medicare revalidation, provider CAQH management, provider portal attestation, and setting up the recredentialing due date. Manage provider demographic updates, such as adding or removing an address in practice, or adding a new provider, NP, or PA.

Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.
. Keep track of expiration dates for state DEA licenses, board certifications, and malpractice insurance for individual providers.

Track contracted Managed Care Organizations, commercial payers, CMS Medicare, Medicaid, PECOS, NPPES, and CAQH to ensure all portal logins are active and accessible.

Also, I was doing contract negotiation for a new contract and existing contract renegotiation.

• Collaborate with providers to ensure timely updates to their CAQH database files, as per CMS Medicare.

Strong knowledge of credentialing documentation, insurance portals, and provider onboarding.

Assisting with setup of new practice and new providers and responsible for onboarding new providers until completion, providing weekly reports to providers regarding credentialing progress and updates

• Managed client relationships to ensure satisfaction and retention. Organized regular meetings with clients to discuss upcoming projects and initiatives.
• Developed and maintained policies for credentialing compliance and quality assurance.
• Conducted regular audits to identify areas for improvement in credentialing workflows.
• Implemented technology solutions to streamline credentialing documentation and tracking.
• Developed and monitored policies and procedures related to the Credentialing process.
• Maintained files on all providers including current licenses and certificates of insurance
• Conducted credentialing applications, verifications, and renewals
• Set up NPI numbers for providers and facilities and updated current profile information.
• Managed end-to-end provider credentialing process, ensuring compliance with industry standards.
• Reviewed reports on employee attendance, productivity and effectiveness to evaluate performance.
• Managed credentialing processes for healthcare providers efficiently and accurately.
• Also, I had work for Hospital Credentialing to get to obtain the hospital affiliation.

• Managed client communications to resolve inquiries and enhance service delivery by providing requested reports on revenue, billing, payment, and missing pending items from provider list.
• Patient eligibility and benefits.
• Oversaw revenue cycle management tasks, including charge posting and claims submission.
• Ensured accuracy in payment posting and managed denial corrections for provider billing.
• Trained new team members on operational procedures, emphasizing safety compliance.
• Collaborated with team members to implement efficiency-enhancing process improvements.
• Maintained detailed documentation of patient care activities and relevant reports.
• Monitored staff adherence to safety regulations to ensure a secure work environment.
• Produced thorough, accurate and timely reports of project activities.

• Oversaw daily functions of Billing Department, including charge entry and reimbursement management.
• Entered CPT codes and patient information into billing software to ensure accuracy.
• Reviewed and validated charges for services, ensuring compliance with documentation policies.
• Collaborated with medical providers to establish billing practices and maintain compliance.
• Completed and submitted CMS-1500 Forms for various specialties, including podiatry and dermatology.
• Communicated with insurance companies to monitor claim status and expedite processing.
• Established relationships with 25 major insurance companies, cutting claim follow-up time by 95%.
• Implemented a system providing alerts on unpaid claims, speeding up resolution processes.

• At there my role and responsibility was Monitoring incoming emails with enquiries and handle Inbound & Outbound calls.

• In that organization my role and responsibility was Interacting with the customer and Solving their queries and Taking Feedback from Customers and Forwarding to appropriate Department and Authority so they can improve the Service.

• At that organization my role and responsibility was to provide cost reduction, driving business performance improvements across processes spanning revenues, cash flow and capital utilization as well as maximizing customer satisfaction, and enhancing overall competitive advantage of the client organization.