PRIYADHARSHINI A

I am a dedicated Provider Enrollment and Credentialing Specialist with hands-on experience in Medicare, Medicaid, and Commercial plan enrollments and credentialing processes. I have worked on large healthcare platforms and supported providers through CAQH attestation and provider data maintenance.

At Accenture (Apollo/Aetna project) I specialized in provider plan setups, member enrollment and termination, and ensured compliance with CMS, state, and payer guidelines across credentialing activities. I regularly used PECOS, CAQH, NPPES, WONDERTOOL, MGB, CREDVIEWR, eTQS and other validation portals.

My claims experience includes adjudication, denial management, payment processing, and adjustments in Oracle; I identified root causes for denials and improved claim approval rates by 15%. I am proficient with Omniflow on the WellCare platform and member data updates in Xycelys.

I bring strong attention to regulatory compliance, collaboration with underwriters and sales for plan coding, and practical knowledge of Excel, Word and PowerPoint. I continuously pursue learning opportunities, including certifications in Python and Java Full Stack.