Shanthi Dinesh Kumar

Hyderabad

Summary

Results-driven Operations Manager with over [10] years of experience in US healthcare EDI and revenue cycle operations, specializing in managing end-to-end electronic data interchange processes. Proven expertise in handling high-volume healthcare transactions (837, 835, 270/271, 276/277), streamlining data workflows, and ensuring compliance with HIPAA, ANSI X12, and CMS regulations. Adept at hiring, training, and leading cross-functional teams, optimizing clearinghouse relationships, and improving claims acceptance rates and turnaround times. Strong background in process automation, issue resolution, and aligning EDI operations with organizational goals to enhance payer-provider collaboration and cash flow efficiency.

Overview

years of professional experience

Work History

Sutherland Healthcare Solutions

Team Manager - EDI

08.2022 - Current

Job overview

Led end-to-end execution of a high-impact EDI project, overseeing healthcare data exchange processes between payers and providers.
Recruited, onboarded, and trained a dedicated team of EDI analysts and specialists, growing the team from [X] to [Y] members.
Created and implemented standardized training programs, SOPs, and process documentation, ensuring team readiness and knowledge consistency.
Streamlined EDI workflows by automating claim submission and reconciliation processes, reducing manual intervention by 40% and boosting first-pass claim acceptance.
Collaborated with clearinghouses (Change Healthcare, Optum, Availity) to resolve file rejections, mapping errors, and ensure compliance with HIPAA and ANSI X12 standards.
Implemented KPI dashboards to monitor EDI performance, claim rejections, and transaction throughput, enabling real-time data visibility for leadership.
Partnered with IT and RCM teams to integrate EDI processes with internal systems and improve cash flow cycle.

Sutherland Healthcare Solutions

Lead (Application Support)

01.2016 - 05.2019

Job overview

Responsible for reviewing and formatting incoming client data for the purpose of building and maintaining the content within a clients customized Software system
Manage incoming data cases from a customer support system – case requests ranging from highly complex new builds to relatively simple maintenance
Strong computer literacy with an emphasis on excel analysis and modification
Interacting with clients as and when required for the newer updates

Sutherland Healthcare Solutions

Subject Matter Expert (Operations)

07.2014 - 12.2015

Job overview

Monitor and ensure that daily productivity and quality levels of team members meet project standards
Co-ordinate with quality team for updates and process changes and ensure adherence to the compliance policies and procedures
Identify training needs and conduct training to various team members on systems and procedures
Guiding team to get the proper resolution of the accounts
Preparing Productivity & Downtime report on a weekly basis and sharing it to the respective manager
Assigning/ allocating the work to the team members in the presence/ absence of the TL/ Manager
Responsible to Plan a strategy and roadmap to resolve accounts receivable and allocate/assign claims to team members
Responsible to Co-ordinate with client service teams and onsite reps to identify and resolve project specific issues and procedures
Responsible to recognize the skills of key team members and utilize their strengths to the benefit of the team
Maximum Team size handled is 32

Sutherland Healthcare Solutions

Lead Quality

06.2013 - 06.2014

Job overview

Regular Audits as per the target on the assigned Project within the stipulated Timeframe
Maintaining TAT of 48 hours in the regular audits
Process Audits, Process level Analysis, Trend Analysis and Process Awareness
Conducting effective refresher training, Weekly and monthly Feedback Sessions to the agents who are below Threshold or in a Focused group
Check list/ Process Flows/ Job AID- Update once in a Month (Validated by Operations team)
Escalating and resolving issues and make them updated in SOP’s
Generate reports (In & out flow reports for Huron clients) for tracking aging and high dollar claims, forecasting cash collection, and client reporting
Maximum team size handled is 28

Sutherland Healthcare Solutions

Analyst And Senior Analyst

03.2010 - 05.2013

Job overview

Achieving daily Productivity and Quality as per SLA
Call the payers for claim resolution in favor of providers
Identifying the issues and resolving them, being either provider issues, provider credentialing issues, or any kind of front-end rejections which restrict the payers in paying the claims
Insurance follow-up on hospital claims (hospital claims for services rendered in a multispecialty hospital)
Handling denial management with the ability to send the claims for reprocessing/review on the call if denied incorrectly by the payers
Worked on IN Medicare & Medicaid, NC Medicare & Medicaid
Responsible for sharing updates with the team on regular basis
Attending inbound calls of medical insurance companies and patients toward queries and giving correct and timely feedback
Maintaining record of correspondence with insurance companies through mails and faxes of important documents like corrected bills, medical records, remittance, reprising sheets, denial letters, and checks
Proactively identifying and escalating issues and improving existing follow-up processes
Co-ordinate with client service teams and onsite reps to identify and resolve project specific issues and procedures
Mentored new joiners and trained them in the process

Education

DGCA (Director General of civil Aviation)

Graduation from Aircraft maintenance Engineering

01.2009

Board of Intermediate education

Intermediate

01.2004

Skills

EDI transaction oversight
HIPAA Compliance & Data Privacy
Efficient claims administration
Data exchange coordination
EDI onboarding processes
Rejection/Error Resolution & Root Cause Analysis

Operational & Managerial Skills

Team Hiring, Training & Performance Management
Cross-functional Team Leadership (RCM, IT, Billing)
SLA & KPI Monitoring and Reporting
Workflow Optimization & Automation
Process documentation and standardization
Strategic Planning & Execution
Expertise in Excel functions and data analysis
Issue resolution with Jira and Salesforce

Certification

Best performer award, Sutherland Healthcare Solutions, Recondo project, 17/01/17
Star of the Month & Pat on the back awards, Sutherland Healthcare Solutions, Partners project, 15/01/15
Dream Team award, Sutherland Healthcare solutions, Wakemed project, 12/01/12
Client location visit for training, Denver, Colorado, 17/01/17