Dhurgadharan Vijayakumar

• Managed end-to-end AR follow-up, denial management, and claims reconciliation for multiple US healthcare provider
accounts using Athenahealth, Modmed, and Availity, ensuring timely resolution of outstanding claims.
• Analyzed denied and underpaid claims by interpreting EOBs/EOPs and payer-specific guidelines, driving improved
reimbursement rates and measurably reducing the 90+ day aging AR bucket.
• Coordinated directly with insurance payers and internal billing teams to resolve complex billing discrepancies, reducing
average claim turnaround time through proactive escalation workflows.
• Consistently maintained productivity, quality accuracy, and SLA targets above threshold while enforcing strict HIPAA
compliance across all claim activities.

• Led, coached, and performance-managed a 20-member AR team across RCM functions — insurance follow-up,
denial management, and payment posting — consistently achieving team productivity and quality targets in a
fast-paced revenue cycle environment.
• Implemented a real-time performance monitoring framework using custom Excel dashboards and KPI scorecards,
tracking 8+ metrics (productivity, quality, denial rate, aging, SLA adherence) to enable data-driven decision-making
and reduce SLA breaches.
• Delivered structured bi-weekly 1:1 coaching sessions and Performance Improvement Plans (PIPs) for
bottom-quartile performers, improving individual output and reducing team attrition.
• Partnered with QA, Operations, and Client Services teams to identify workflow bottlenecks and implement process
improvements, resulting in measurable gains in first-call resolution rates.
• Conducted performance evaluations, team training, and new-hire onboarding for RCM workflows, payer-specific
guidelines, and denial management strategies — significantly reducing ramp-up time for new analysts.
• Developed and maintained reporting dashboards presented to senior management to track team health, denial trends,
and client satisfaction metrics.

• Executed end-to-end AR processes for US healthcare providers — conducting insurance follow-ups via phone and
online portals (Availity, Modmed, EPIC, Athena, Meditech) to resolve unpaid and denied claims across commercial
and government payers.
• Analyzed aging AR reports daily to prioritize high-value unpaid claims, contributing to a consistent reduction in the 90+
day aging bucket and improving overall cash flow for assigned accounts.
• Resolved claim denials by interpreting Explanation of Benefits (EOBs) and Explanation of Payments (EOPs),
identifying root causes, and initiating corrective actions or escalations as appropriate.
• Trained and mentored junior AR callers on denial management strategies and payer-specific guidelines, improving
team accuracy and first-call resolution rates.
• Maintained meticulous documentation of all call activity, follow-ups, and resolutions in client billing systems, ensuring
audit-ready records and full HIPAA compliance.

• Managed comprehensive AR activities — insurance follow-up, denial management, and payment posting — for
multiple US healthcare clients across EPIC, NextGen, and Karen billing platforms.
• Performed in-depth analysis of aged claims to prioritize and resolve unpaid/denied accounts, reducing outstanding AR
and improving client cash flow through targeted payer outreach.
• Engaged commercial and government payers (Medicare, Medicaid, BCBS, UHC, Aetna) via phone and portal-based
follow-ups to secure claim status updates and secure timely reimbursements.
• Identified systemic denial trends and underpayment patterns, initiating corrective workflow changes and escalating
complex cases to appropriate departments.
• Trained and supported junior team members, sharing payer-specific knowledge and contributing to process
improvement initiatives that enhanced team efficiency.

• Conducted insurance follow-ups with US payers to resolve outstanding claims and reduce AR days, consistently
meeting daily productivity and quality benchmarks.
• Reviewed denial codes, EOBs, and claim statuses to identify and correct billing errors, then contacted payers via
phone and portal to dispute and resolve claims.
• Gained broad exposure to healthcare billing software and payer-specific requirements across commercial and
government plans, building a strong RCM foundation.
• Maintained strict adherence to HIPAA and company confidentiality standards across all claim activities.