Kiran K Kumar
Sharjah
Summary
Seasoned professional with over 10 years in healthcare, specialising in health insurance and end-to-end medical billing project management. Expertise in revenue cycle management, insurance reconciliation, and relationship management. Led teams to optimise processes, enhancing operational efficiency and supporting improved patient care.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Manager - RCM, Insurance, Networking and Pricing
DRFK Turkish International Day Surgery Center
Dubai
12.2025 - Current
- Oversee insurance operations including pre-authorization, claims processing, submission, resubmission, reconciliation and collections.
- Lead department operations, plan and design workflows, and make strategic decisions on work patterns.
- Built empanelment and networks with insurance companies, corporates, and TPAs; developed business plans and innovative strategies to enhance negotiation outcomes.
- Monitored critical areas including medical coding, insurance billing, pre-auth TAT, denial management, and customer service; ensured team cohesion and met quality indicators (error rate, rejection rate, TAT).
- Analyze variances, implement corrective actions, solve problems, and conduct regular staff training on processes like approvals, claim verification and processing, reconciliation, e-claims, and DRG systems.
- Coordinate with clinical heads to align physician practices with payer requirements and reduce denials.
- Deliver monthly dashboards on AR, denials, and collections for senior management.
- Enforce policies, develop SOPs, maintain productivity standards, and focus on achieving results.
- Make pre-authorization decisions and liaise with insurers for outpatient and inpatient approvals.
- Conduct verification/medical audits, submit e-claims, and handle corporate claim submissions via email.
- Develop process improvement strategies for the insurance department and design HIMS solutions.
- Integrated insurance data into HIMS to automate prior approvals and optimise workflow efficiency.
Supervisor - RCM and Reconciliation
MEDICLINIC Parkview Hospital
Dubai
12.2021 - 12.2025
- Managed revenue cycle processes, focusing on submission, resubmission, and reconciliation.
- Enhanced collections and cash flow through reduction of Days Sales Outstanding (DSO).
- Deliver monthly dashboards on AR, denials, and collections for senior management.
- Coordinated with clinical heads to align physician practices with payer requirements, minimising denials.
- Enhance TRAKCARE workflows, streamlining insurance and billing operations.
- Collaborate with Legal to manage licensing and contractual agreements in compliance with UAE laws.
Senior Executive / Supervisor
Zulekha Hospital
Dubai
09.2019 - 11.2021
- Managed insurance approval processes for outpatient, inpatient, and pharmacy services.
- Networked with insurance companies and TPAs, developed insurance approval plans and innovative strategies to reduce rejections and efficiently closed reconciliation books.
- Led Insurance approval and reconciliation department, planned and designed work patterns to optimise departmental efficiency.
- Monitored key processes, including medical coding, preauthorisation turnaround times, and denial management to ensure compliance and accuracy.
- Team building, maintain quality indicators (Error rate, Rejection rate, TAT), analysing variances, initiating corrective actions, problem solving, regular training & orientation of employees on different process like Approval, claim verification & processing, reconciliation, E-Claims, and DRG system etc.
- Coordinating and enforcing policies, developing standard operating procedures, and maintaining productivity standards, working for the results.
Specialist - Insurance relationship management and Reconciliation
ACCUMED Practice Management
Dubai
04.2016 - 07.2019
- Analysed provider profiles, initiated new empanelments and network inclusions, revised tariffs based on current and projected revenue, conducted thorough contract reviews and negotiations, performed DRG analysis, automated processes through HIMS, and monitored insurance billing.
- Reconciled provider outstanding claims, analysed denial trends, and negotiated with payers to minimise final rejection and unpaid rates.
- Led reconciliation, contracting & pricing team, designed workflows, strategised business plans based on provider needs, identified revenue leaks, proposed solutions, oriented internal and external customers, and maintained strong business relationships.
Education
MBA - Finance
Dr. B. R. Ambedkar University
Delhi01-2017
Bachelor of Commerce -
Karnataka State University
Mysore01-2014
Pre - University course in science -
St Philomena's Pre University College
Mysore01-2008
Matriculation High School Diploma -
St Philomena's High School
01-2005
Skills
- Revenue cycle management
- Claims processing
- Medical coding
- Insurance negotiation
- Data analysis
- Microsoft Office Suite
- Corel Draw
Certification
- Lean Six Sigma certified
- CPC, AAPC
- Fitness Trainer C+ level
Languages
English
Hindi
Kannada
Telugu
Marathi
Sanskrit
Arabic
Hobbies and Interests
- Designing cover page of books and articles
- Travelling and exploring
- Photography
- Physical fitness
Hobbies and Interests
- Cycling & Hiking
- Gymming
- Soccer
Timeline
Manager - RCM, Insurance, Networking and Pricing
DRFK Turkish International Day Surgery Center
12.2025 - Current
Supervisor - RCM and Reconciliation
MEDICLINIC Parkview Hospital
12.2021 - 12.2025
Senior Executive / Supervisor
Zulekha Hospital
09.2019 - 11.2021
Specialist - Insurance relationship management and Reconciliation
ACCUMED Practice Management
04.2016 - 07.2019
MBA - Finance
Dr. B. R. Ambedkar University
Bachelor of Commerce -
Karnataka State University
Pre - University course in science -
St Philomena's Pre University College
Matriculation High School Diploma -
St Philomena's High School