Pravalika Kommareddy
Senior Quality Analyst
Hyderabad
Summary
Senior Quality Analyst specializing in the healthcare revenue cycle, with 6 years of experience leading initiatives to optimize financial performance and ensure process integrity. Expert in designing and implementing robust quality assurance frameworks for claims processing, denial management, and accounts receivable operations. Proven ability to enhance workflow efficiency, reduce costs, and mitigate revenue loss through data-driven root-cause analysis and strategic improvement initiatives. Seeking to leverage my expertise to advance quality and compliance at a progressive healthcare organization.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Sr Quality Analyst
AMPS Healthcare India Pvt ltd
08.2022 - 08.2025
- 3 years of experience in AMPS Healthcare India Pvt ltd as Senior Quality Analyst.
- Certified in LSSBB.
- Ensure processes adhere to regulatory standards (HIPAA and CMS).
- Provided feedback and coaching to team members to improve performance.
- Conducted refresher training on quality standards, compliance requirements, and best practices.
- Developed and updated standard operating procedures (SOPs) and quality checklists.
- Facilitated training sessions for junior analysts on best practices and quality standards.
- Participated in client calls and quality calibration sessions.
- Acted as a subject matter expert (SME) on quality assurance in U.S. healthcare processes.
- Reviewed and revised quality documentation, ensuring compliance standards.
- Analyzed performance metrics, identifying areas for improvement in quality control processes.
- I worked on the Solidarity healthcare claim adjudication process.
- Strong knowledge of medical coding and billing, including ICD-10, CPTs, CMS-1500, UB-04 claim forms, etc., as well as EOB reviews, and analyze the data for claims in process in order to identify and resolve errors prior to final adjudication.
- Experience: A total of 6 years of experience in U.S. healthcare.
Pre-Auth Analyst
Infinx Pvt Ltd
03.2021 - 06.2022
- 1.3 years of experience in Infinx as Prior Authorization analyst.
- Calling insurance to take prior authorization
- Provide clinicals verbally while on call with payer after reading clinical notes.
- Talk to payer nurse when in need to ensure smooth approval of prior auth in critical cases
- Faxing required clinicals to payer when needed
- Extensive experience in Cardiology projects
- Handling priority accounts which are time and payer sensitive (TAT and STATs)
- Have thorough knowledge on initiating Pre-authorization through payer portals (AIM/Evicore/Carecore etc.)
- Mentored new hires on project specific client system/process
- Allocation of work to mentees
- Monitor teams’ quality and production
- Conduct training to team members on all process updates and as when required
- Feedback to mentees on their daily performance based on the previous day's production and quality
- Periodical correspondence with Team Leads and Project Leaders on all work-related issues.
Senior Associate
IKS Health
12.2016 - 04.2018
- 1.5 Years of experience in AR calling & Denial Management.
- Resolving Medical Claims and non-callable accounts which can be worked through the portal
- Prioritization of claims from the given sample ensuring the timely completion of claims and reports
- Identified trends in issues, escalating and resolving such issues identified
- Adhere to quality improvement initiatives.
- I have been a part of the appeals team which deals with appealing the claims ensuring there is no breach of compliance
- Provide end stage resolution to all pending claims and future claims from getting denied by finding global issues
- Worked on special projects and client priorities
- Strictly following the HIPPA & Compliance as per the guidance from the US Federal Law
- Exceeded the promised levels of productivity and quality
- Interact with US Insurance companies to resolve medical claims
- Identified trends in issues, escalating and resolving such issues identified.
- Worked on special projects and delivered timely on client priorities
- Maintained a continuous and consistent trend in meeting and exceeding the set levels of productivity and quality
Education
MBA -
Princeton PG College of Management
04.2021
Bachelor of Science - Computer Science
St. Ann’s College for Women
04.2016
Skills
- Quality & Audit Processes
- Attention to Detail & Critical Thinking
- Good written and verbal communication skills
- HIPAA Compliance Understanding
- Mentoring Skills
- Client Communication
- Performance Metrics
- Decision Making Skills
- Time Management Skills
- Good Knowledge on MS office
Certification
LSSBB - Lean Six Sigma Black Belt
Interests
Singing, Cooking
Disclaimer
I do hereby declare that the information contained herein is true and correct to the best of my knowledge and belief. Date: Place: Hyderabad Kommareddy Pravalika
PROFESSION EXPECTATION
Looking for good position in a reputed Company with career growth
Timeline
Sr Quality Analyst
AMPS Healthcare India Pvt ltd
08.2022 - 08.2025
Pre-Auth Analyst
Infinx Pvt Ltd
03.2021 - 06.2022
Senior Associate
IKS Health
12.2016 - 04.2018
Bachelor of Science - Computer Science
St. Ann’s College for Women
MBA -
Princeton PG College of Management
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