Vinod Kumar Nenavath
Hyderabad
Summary
Goal-oriented provider credentialing specialist with extensive experience in US healthcare operations, provider enrolments, and compliance management. Expertise in end-to-end credentialing, ensuring adherence to NCQA, CMS, and HIPAA regulations. Skilled in optimizing credentialing workflows, reducing processing times, and enhancing provider data accuracy. Adept at collaborating with providers, payers, and internal stakeholders to streamline credentialing and network enrolment. Passionate about implementing innovative solutions to improve credentialing efficiency and regulatory compliance. Lead and supported a team which lead to enhancement of accuracy and productivity
Overview
8
8
years of professional experience
Work History
Senior Process Specialist
Thryve Digital LLP
07.2024 - Current
- Managing end-to-end provider credentialing processes for insurance companies
- Ensuring compliance with regulatory requirements and maintaining up-to-date provider records
- Collaborating with cross-functional teams to improve workflow efficiency
- Reviewing and verifying provider documentation, licenses, certifications, and background checks
- Maintaining accurate provider records and updating credentialing databases
- Streamlining credentialing workflows, reducing processing times, and improving efficiency
- Coordinating with providers, payers, and internal teams to resolve credentialing issues
Sr. Pharma benefit analyst
Optum global solutions
03.2017 - 08.2022
- Developed customized healthcare plans for customers based on their needs
- Validated and processed benefit plans with a strong focus on accuracy and compliance
- Conducted training sessions for new employees, enhancing team efficiency
- Assisted in handling a team and ensuring smooth workflow execution
Education
MSc - Public health
University of East London
London, UK01-2024
Bachelors of Pharmacy -
TKR College of Pharmacy
Hyderabad, India05-2016
Skills
- Strong organizational skills
- Attention to detail
- Provider Credentialing & Enrolment
- Healthcare Compliance & Regulations
- US Healthcare Insurance Process
- Team Leadership & Training
- Process Improvement & Optimization
- MS Office Suite
- Data Validation & Management
- Stakeholder Communication
- Cross-functional Team Collaboration
Disclaimer
I hereby declare that the above-mentioned information is correct up to my knowledge and I bear the responsibility for the correctness of the above-mentioned particulars.
Hobbies and Interests
- Participation in sports or physical activities like cricket, running, and cycling.
- Volunteering at local animal shelter.
Rewards Recognition
- Received the Employee of the Year award twice.
- Earned Onshore Bravo recognitions for outstanding performances.
- Honored with numerous Star Awards and Venus Star Awards.
Languages
Telugu
First Language
English
Proficient (C2)
C2
hindi
Proficient (C2)
C2
Gujarati
Intermediate (B1)
B1
Timeline
Senior Process Specialist
Thryve Digital LLP
07.2024 - Current
Sr. Pharma benefit analyst
Optum global solutions
03.2017 - 08.2022
MSc - Public health
University of East London
Bachelors of Pharmacy -
TKR College of Pharmacy
Similar Profiles
Rajendran MuthuswamyRajendran Muthuswamy
Senior Consultant at THRYVE DIGITAL LLPSenior Consultant at THRYVE DIGITAL LLP
Sanjay SSanjay S
Epic HB/PB Consultant at Thryve Digital LLPEpic HB/PB Consultant at Thryve Digital LLP
NITHIN JAYASANKARNITHIN JAYASANKAR
Product Manager at Thryve Digital LLPProduct Manager at Thryve Digital LLP