Healthcare Billing & Data Management Specialist

VINAY KUSUMA

Dallas, TX +1-469-***-**** ***************@*****.***

PROFESSIONAL SUMMARY

Healthcare operations and medical billing professional with 5+ years of experience supporting medical claims processing, healthcare data management, billing reconciliation, and revenue cycle operations within payer and provider environments. Experienced in handling large volumes of healthcare and billing data while maintaining HIPAA compliance, data accuracy, and operational efficiency. Skilled in claims processing, insurance verification, medical documentation review, reporting, and resolving billing discrepancies across fast-paced healthcare environments. Strong background in healthcare data analysis, administrative coordination, patient confidentiality, and operational support.

TECHNICAL SKILLS

• Medical Billing & Revenue Cycle: Medical Billing, Claims Processing, Revenue Cycle Management (RCM), Payment Posting, Insurance Verification, Billing Reconciliation, Accounts Receivable (AR) Follow-Up, Charge Entry

• Claims Processing & Insurance: Claims Submission, Denial Resolution, Claims Validation, Eligibility Verification, Claims Adjudication, Appeals Processing, Patient Account Resolution

• Healthcare Compliance: HIPAA Compliance, PHI Handling, Healthcare Documentation, Regulatory Compliance, Medical Records Management, Audit Readiness

• Healthcare Data Management: Healthcare Data Processing, Data Entry, Data Validation, Billing Reports, Billing Data Auditing, Claims Trend Analysis, Record Maintenance

• Systems & Tools: EMR/EHR Systems, Medical Billing Software, Microsoft Excel, Microsoft Office Suite, Outlook, SharePoint, ICD/CPT Familiarity

• Administrative Support: Documentation Management, Cross-Functional Coordination, Time Management, Process Improvement, Administrative Coordination

PROFESSIONAL EXPERIENCE

McKesson Sep 2024 - Present

Healthcare Data & Medical Billing Specialist USA

• Managed large volumes of healthcare billing and patient-related data while ensuring high levels of accuracy, confidentiality, and HIPAA compliance across daily operations.

• Processed over 1,200+ medical claims weekly involving billing updates, payment reconciliations, insurance verification activities, and claims validation workflows within fast-paced healthcare operations environments.

• Led data validation and billing review activities, reducing claim processing discrepancies by 25% and improving billing accuracy across operational workflows.

• Coordinated with healthcare providers, billing teams, and insurance representatives to resolve billing issues, claim denials, and payment inconsistencies, improving resolution turnaround time by 20%.

• Maintained accurate healthcare records and billing documentation across EMR and billing systems while ensuring compliance with internal policies and HIPAA regulations.

• Conducted billing data analysis and reporting activities to identify operational trends, recurring claim issues, and process improvement opportunities across revenue cycle operations.

• Assisted in preparing operational reports, claims summaries, and billing performance metrics for internal stakeholders and management review.

• Performed quality assurance checks on healthcare data, patient records, and billing transactions, contributing to a 30% reduction in manual correction efforts.

• Supported process improvement initiatives focused on reducing billing turnaround times and improving overall claims processing efficiency across healthcare workflows.

• Collaborated with cross-functional healthcare and administrative teams to ensure seamless claims processing and accurate patient account management.

AGS HealthCare Aug 2022 - Jun 2023

Healthcare Claims Analyst India

• Managed healthcare claims processing workflows involving insurance claims review, billing validation, payment posting, and patient account reconciliation activities.

• Reviewed and analyzed billing records, claims submissions, and healthcare documentation to ensure compliance with payer guidelines and HIPAA regulations.

• Investigated billing discrepancies, claim denials, and payment variances, improving claims resolution efficiency by 22% and reducing recurring processing errors.

• Conducted healthcare data validation and claims auditing activities to improve operational accuracy and maintain billing compliance standards across high-volume claims environments.

• Worked extensively with Excel and healthcare billing systems to maintain claims records, monitor billing trends, and generate operational reports supporting daily business operations.

• Collaborated with providers, insurance teams, and internal billing departments to resolve claims-related issues and support timely reimbursements.

• Maintained confidentiality and security of patient health information while processing healthcare records and billing transactions involving PHI-sensitive data.

• Assisted in improving claims workflows and operational procedures through process documentation and billing quality review activities, reducing manual processing delays by 18%.

• Supported reporting and administrative functions related to claims processing, billing reconciliation, and revenue cycle operations. Optum Jan 2020 - Jul 2022

Medical Billing Associate India

• Processed medical billing transactions, healthcare claims, and insurance-related documentation across high-volume healthcare operations environments supporting payer and provider workflows.

• Maintained accurate patient billing records and healthcare documentation while ensuring compliance with HIPAA and healthcare data privacy standards.

• Reviewed billing information, insurance eligibility, and patient account details to ensure accurate claim submissions and timely reimbursement processing.

• Performed healthcare data entry, claims validation, and payment posting activities with over 98% billing accuracy across daily operational workflows.

• Assisted in identifying and resolving billing inconsistencies, denied claims, and patient account discrepancies across multiple healthcare systems.

• Generated operational and billing reports using Excel to support claims monitoring, reconciliation activities, and process tracking initiatives.

• Coordinated with healthcare teams and insurance representatives to support efficient claims handling and patient account resolution.

• Supported administrative and documentation management activities related to medical billing workflows and healthcare record maintenance.

• Contributed to operational improvement initiatives focused on improving billing turnaround time and reducing manual processing errors by 15%.

PROJECTS

Healthcare Claims Data Validation & Reporting Initiative

• Developed billing validation workflows and reporting processes to improve healthcare claims accuracy and reduce operational discrepancies.

• Analyzed healthcare billing data and claims trends to identify recurring denial patterns and support process improvement recommendations.

• Assisted in improving operational reporting visibility through Excel-based tracking and billing reconciliation activities. EDUCATION

University of North Texas, Denton, TX Aug 2023 - May 2025 Master of Science, Computer Science Denton, TX

CERTIFICATIONS

• HIPAA Compliance & Healthcare Privacy Certification

• Medical Billing and Coding Fundamentals

• Microsoft Excel for Business & Reporting

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