Summary

Overview

Work History

Education

Skills

Software

Timeline

Navin Kumar

AR/QCA US Healthcare (RCM)

Kolar,KA

Summary

Detail-driven Healthcare RCM professional with foundational experience as an AR Caller Intern, specializing in DME, complex denials, and appeals. Leveraging expertise in clearinghouses to transition into a Quality Control Analyst (QCA) role. Proven track record in auditing technical billing accuracy

Overview

years of professional experience

Work History

Quality Control Analyst

Healthcare Informatics

07.2025 - 05.2026

Conducted routine quality assessments to ensure compliance with regulatory standards.
Maintained detailed records of inspections, tests, and corrective actions taken.
Conducted root cause analysis for recurring issues, developing long-term solutions to prevent recurrence.
Provided training to new hires on quality control procedures, fostering a culture of excellence within the team.
Improved overall production efficiency by identifying and resolving quality control issues.

Senior Executive/Quality Control Analyst

Omega Healthcare Management Services Private

03.2022 - 01.2025

Track daily, weekly, and monthly quality trends to report to operations management, Call Monitoring and Evaluation
Conduct one-on-one feedback sessions to help agents understand their performance gaps
Created detailed reports on quality trends, providing insights for executive decision-making processes.
Established key performance indicators to measure effectiveness of quality control initiatives.
Enforce HIPAA compliance to protect patient Health Insurance Portability and Accountability Act standards.

Senior Client Partner

Access Healthcare Services Pvt Ltd

10.2020 - 03.2022

Validated and processed DME orders, ensuring precise documentation of certificates of medical necessity (CMN) and prescriber orders.
Drafted and submitted Level 1 appeal/Reconsiderations letters, backed by medical necessity documentation, clinical notes, and proof of prior authorization
Maintained an average daily call volume of 30+ Conversation with insurance representatives while maintaining a 95%+ quality score.
Analyzed and resolved complex claim denials.Reduced aging AR buckets (greater than 90 days)

Senior Executive

Omega Healthcare Management Services Pvt Ltd

02.2020 - 10.2020

Self-motivated, with a strong sense of personal responsibility.
Worked effectively in fast-paced environments.
Skilled at working independently and collaboratively in a team environment.
Proven ability to learn quickly and adapt to new situations.
Demonstrated respect, friendliness, and willingness to help wherever needed.

Intern

Global Healthcare Resource

04.2019 - 02.2020

Mastered US Healthcare RCM fundamentals, including the life cycle of a claim, provider-patient-payer relationships, and basic medical billing terminology.
Insurance Follow-up & Operations,Maintained a high accuracy rate in data entry while documenting claim statuses, minimizing errors in internal tracking sheets
Organized and prepared supporting documentation, such as medical records and prior authorizations, required for the submission of clean claims and appeals.

Education

Diploma in Mechanical Engg

Government Polytechnic

Kolar Gold Fields

04.2001 -

Skills

DME Knowledge, Accounts Receivable (AR) Liquidation: Skilled at reducing outstanding and recovering aging claims

RCM Software Proficiency,Experience navigating EHR/EMR platforms & HIPAA Compliance & PHI Security

Clearinghouse Navigation & Electronic Billing, Complex Claims Resolution