Vinothkumar Vijaya

I’m a Certified Healthcare RCM Specialist with proven expertise in denial management, referrals, benefits & eligibility verification, and insurance verification. I combine deep medical billing knowledge with a strong quality mindset to ensure accuracy, compliance, and efficiency in every step of the claims workflow.

In my senior roles, I’ve focused on reviewing AR caller work, auditing call quality across conversational skills, claims resolution, and voice quality, and documenting quality issues. I provide feedback and work with training teams to deliver remedial training that improves performance and strengthens consistency across the process.

I take ownership of escalated, high-level claim denials and rejections by analyzing insurance payer guidelines, medical records, and Explanation of Benefits (EOBs) to determine the appropriate appeal actions. My goal is to reduce claim denials, speed up resolution, and support organizational growth through process excellence.

I also manage day-to-day accounts receivable activities such as following up with insurance companies using their websites and outbound calls to understand claim status. Across EPIC and Athenahealth tools, I stay committed to compliance standards and ethical behavior while continuously solving problems and building strong working relationships.