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Hemakumar _B

@hemakumar_b

Quality Control Analyst specializing in multispecialty denial management, coding accuracy, and regulatory compliance, optimize revenue cycles.

India

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What I'm looking for

I’m looking for a role where I can own denial quality audits, strengthen coding accuracy and compliance, and partner with coders to resolve root causes. I want a team that values continuous quality improvement and clear feedback loops.

I’m a Quality Control Analyst with 8 years of denials medical coding experience, focused on multi-specialty claims and a wide range of denial types. I prioritize coding accuracy, compliance, and efficient denial resolution to protect revenue integrity and drive continuous quality improvement.

Experienced healthcare administration professional with extensive expertise navigating major provider portals, including CareSource, UHC, Cigna, Anthem, and Humana. Well-versed in CMS guidelines, ensuring accurate claims processing, efficient utilization management, and strict regulatory compliance to optimize revenue cycle operations.

In my current role as a Quality Analyst, I perform detailed quality audits on denied coded claims to verify accuracy, completeness, and alignment with regulatory and payer guidelines. I provide feedback to coders and recommend corrective actions to reduce coding errors and improve overall performance.

Previously, I worked as a Senior Medical Coder handling internal audit for the team and leading training for new joiners, while supporting multi-specialty coding. I addressed coding denials through accurate editing and resubmission of erroneously submitted claims.

Throughout my career, I’ve coded medical records by assigning accurate diagnosis and CPT codes using ICD-10 and CPT systems, including expertise across Medicare, Medicaid, and commercial payer workflows. I’m CPC-certified and bring strong analytical skills to identify trends, root causes, and coding discrepancies.

Experience

Work history, roles, and key accomplishments

Current

Quality Analyst

Current

AGS Health Pvt Ltd

Jun 2025 - Present (1 year)

Perform detailed quality audits on coded claims, with a focus on denied cases, to ensure accuracy, completeness, and compliance with regulatory and payer guidelines. Provide feedback and recommended corrective actions to coders to improve coding quality and denial resolution.

Quality Audits CPT Coding ICD 10 CM Compliance Medical Record Review

Senior Medical Coder

R1 RCM Global Pvt Ltd

Oct 2023 - Jun 2025 (1 year 8 months)

Support internal audit activities for the team and participate in multi-specialty medical coding. Lead training for new joiners to improve coding consistency and accuracy.

Internal Audit Medical Coding Denials Management CPT Coding ICD 10 CM Training Coding Accuracy

Senior Medical Coder

Gebbs Healthcare Solutions Pvt Ltd

May 2022 - Sep 2023 (1 year 4 months)

Address coding denials by editing and resubmitting erroneously submitted claims with accurate diagnosis and procedure coding. Code medical records using ICD-10 and CPT rules to improve submission quality and reduce denials.

Denial Codes CPT Coding Diagnosis Coding Coding Compliance

Senior Medical Coder

Savista Global Solution

Jan 2022 - May 2022 (4 months)

Perform short-term orthopedic-focused denial coding in a multi-specialty environment. Apply accurate coding and edits to support correct claim submissions and denial resolution.

Orthopedic Coding Medical Coding CPT Coding ICD 10 CM Denials Management

Executive Coder

Hinduja Global Solution

Jul 2017 - Jan 2022 (4 years 6 months)

Handle multi-specialty denials coding across areas including E/M, anesthesia, radiology, pathology, and surgical procedures. Make coding corrections based on patient records and address denials to improve claim outcomes.

E M Coding Anesthesia Coding Radiology Coding Pathology Coding Procedure Coding CPT Coding ICD 10 CM