Surajnarayan Tiwari

Sr.Credentialing Specialist

US Healthcare Revenue Cycle Management (RCM) professional with over 9 years of experience across Provider Credentialing, Provider Enrollment, Medical Billing, Accounts Receivable (AR), Eligibility Verification, Patient Support, Client Management, and Revenue Cycle Operations. Possess 4+ years of specialized experience in Provider Credentialing, including CAQH, PECOS, Medicare, Medicaid, Commercial Payer Enrollment, Recredentialing, and Provider Lifecycle Management. Proven ability to manage end-to-end RCM processes, resolve client and payer issues, improve operational efficiency, and maintain compliance standards. Strong expertise in stakeholder communication, team collaboration, and delivering high-quality results in fast-paced US healthcare environments.

[email protected] 8264016895 B 402 Vedrusha Residency, Nr. Sattva International School, New vastral Ahmedabad 382430
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Year experience
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Languages
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Skills
Work Experience
Sr. Credentialing Specialist
EMP Claims Pvt Ltd
Aug 2025 — PresentCurrentAhmedabad
  • Provider Credentialing
  • Provider Enrollment
  • CAQH Management
  • PECOS Enrollment
  • Medicare Enrollment
  • Medicaid Enrollment
  • Commercial Payer Enrollment
  • Recredentialing
  • Provider Data Management
  • Hospital Privileging
  • Medical Billing
  • Accounts Receivable (AR)
  • Denial Management
  • Eligibility Verification (EV)
  • Patient Support
  • Client Query Resolution
  • RCM Operations
  • Team Coordination
  • Process Improvement
  • Quality Assurance
Credentialing Specialist
ACE Healthcare Pvt Ltd
May 2024 — Aug 2025
  • Worked as a Credentialing Specialist, managing the enrollment of multiple providers for the group's Federally Qualified Health Center (FQHC) network.
Team lead AR
Auribus Global Service Pvt Ltd
Nov 2023 — Apr 2024
  • Set individual and team performance goals
  • Provided training to new team members and mentored staff for continuous improvement
  • Implemented process to reduce claim denials and increase first-pass claim acceptance rate
  • Proficient in various medical billing software platforms
  • Identified and resolved billing issues proactively to minimize claim denials and delays
Team coach AR
Integrity Service Pvt Ltd
Feb 2022 — Oct 2023
  • Managed rejection and accounts receivables on claims through interactions with insurance companies
  • Credentialed providers
  • Conducted weekly client discussions on rejections in claims and handled client queries
  • Co-managed a team of 3 people
Team Coach EV
Astron E services pvt ltd
Mar 2021 — Jan 2022
  • Managed dental EV operations and team
  • Handled provider queries
Sr. Client Service Executive
Clinical Excel Computech LLP
May 2017 — Jul 2021
  • Handled dental EV, pasting, and plan creation
  • Managed client reporting
  • Led a team as team lead
Skills
Provider Credentialing Provider Enrollment Recredentialing CAQH Management PECOS Enrollment NPI Registration & Maintenance Medicare Enrollment Medicaid Enrollment Commercial Payer Enrollment Hospital Privileging Medical Billing Accounts Receivable (AR) Follow-up Denial Management
Education
Bachelor of Business Administration
Madurai Kamraj University
2017
Languages
English
Fluent
Hindi
Fluent
Gujarati
Fluent