Pavithra Sakthivel

Credentialing Coordinator.

• Conducted primary source verification for all incoming provider applications, including physicians, nurse practitioners, and allied health professionals.
• Processed applications for initial credentialing and re-credentialing in a timely manner, in compliance with both internal and external accreditation standards (e.g., NCQA, URAC).
• Maintained detailed logs of all credentialing activities, ensuring compliance with internal audits, and regulatory inspections.
• Worked directly with providers and practice administrators to gather required documentation, and resolve any credentialing discrepancies.
• Maintain accurate and up-to-date provider files, ensuring accurate documentation, and compliance with state and federal regulations.

Claims Adjudicator and Claims Adjuster.

• Processed insurance claims, resolved customer inquiries, and maintained accurate records.
• Collaborated effectively with team members to achieve departmental goals and ensure smooth operations.
• Achieved 100% of the target and met the SLAs.
• Managed a caseload of over 150 claims per day, maintaining a 98% accuracy rate.
• Maintained all the claim data in a well-organized Excel format for future references.