Open to opportunities

Dinesh Kumar

@dineshkumar22

Message

I manage end-to-end prior authorization, eligibility, appeals, and escalations across complex healthcare specialties.

India

Message

What I'm looking for

I'm looking for a healthcare prior-authorization or revenue-cycle role where I can manage complex authorizations, eligibility, appeals, provider communication, and escalations across multiple specialties.

I'm currently a Subject Matter Expert in Prior Authorization at MedRCM360, managing end-to-end authorization and insurance verification work across diagnostic imaging, DME, cardiology, and pharmacy.

I've progressed through Associate, Senior Associate, and Subject Matter Expert roles at MedRCM360, handling authorization initiation and status requests, eligibility verification, pre-certification, pre-determination, procedure codes, referrals, and medical-record requests. I also coordinate peer-to-peer calls, appeals, denial management, provider follow-ups, and weekly provider status updates.

I work across eClinicalWorks and Epic and use payer portals including Availity, AIM, RadMD, eviCore, BCBS, UHC Optum, Cohere, New Century, Evolent, Molina, Medicare, and Medicaid.

Earlier, I supported the DME process at Sunrise Infotech, resolving missing-information issues with referral sources, hospitals, doctor offices, insurers, and patients while obtaining prior-authorizations, approvals, appeals, and electronic document signatures.

Experience

Work history, roles, and key accomplishments

Current

Subject matter expert - PRIOR AUTHORIZATION

Current

MedRCM360

Jul 2025 - Present (1 year 1 month)

I do have 6.5 years of experience in medical billing as prior Authorization Specialist along with insurance verification have worked on end to end resolution worked on multiple specialities like diagnostic imaging (Radiology), DME, cardiology, Pharmacy including benefits verification copays, deductible,co insurance.

Worked on multiple EHR like Eclinical Works,Epic etc.

Familiar with all the port

Eligibility Appeals EviCore Prior Authorizations Referrals ICD 10

Senior Associate Prior Authorization

MedRCM360

Jul 2024 - Jun 2025 (11 months)

Calling in behalf of providers and requesting for Authorization status and initiation, members eligibility and verification, pre- certification,pre -determination & initiated Authorization for procedure codes , Follow up with PCP office , requesting medical records Hcpcs Specialist -Cardiology & Knowledge in denial management. Schedule a call for Peer to peer with the provider & medical director.

EviCore IVR Cardiology Appeals

Associate Prior Authorization

MedRCM360

Oct 2022 - Jun 2024 (1 year 8 months)

Calling in behalf of provider and requesting for Authorization status and eligibility and verification, pre- certification, initiated Authorization for procedure codes, Follow up with PCP office ,Hcpcs Specialist -Cardiology & Knowledge in denial management.

Cardiology IVR Authorization Denial Management AR Eligibility Procédures Pre Authorization Referrals

Us health care- DME process

Sunrise Infotech ( Home town medical supplies)

Aug 2019 - Mar 2022 (2 years 7 months)

Sunrise Infotech - DME PROCESS (Mobility-Ambulatory devices)

DME process : Even If any missing information we used to Call Referral , Hospital, Doctor Office, Insurance, Patients also (works on prior Authorization & getting Approvalwith appeal submission ) & We used to send Documents Electronically to require Departments for their Signatures.

Durable Medical Equipment DME Authorization AR Eligibility Prior Authorizations