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Healthcare SME
13+ years in US Healthcare, specializing in payer, claims, RCM, SQL analytics, data validation, EDI, FHIR, HL7, and business analysis.
IndiaHealthcare SME at Cognida.ai
Analyzed healthcare business requirements and data workflows for PDM 2.0 initiatives, translating complex business needs into actionable workflows, user stories, and test scenarios. Partnered with cross-functional teams to apply data analysis, data modelling, and AI concepts to healthcare solutions.
Healthcare AnalyticsData AnalysisData ModelingAISQLUser StoriesTest scenarios
Led business analysis for HealthEdge Member Portal implementations supporting enrollment, claims, payments, and secondary edits. Translated stakeholder needs into actionable functional requirements and coordinated alignment across business and technology teams.
SQLData ProfilingData ValidationReconciliationsRoot Cause AnalysisAPIsHL7FHIREDIUATStakeholder ManagementHIPAA
Managed the end-to-end healthcare claims processing lifecycle from requirements through production, supporting Medicare and Medicaid claims and benefit processes. Analyzed complex healthcare datasets using SQL, Power BI, and Python, developing data models and identifying trends.
SQLPower BIPythonData ModelingUATDefect TriagePayment IntegrityFHIRAPI TestingClaims Processing
Cognizant Technology Solutions
Delivered Revenue Cycle Management process improvements, EMR workflow optimization, and operational process documentation. Supported defect management and business process enhancement initiatives.
Revenue Cycle ManagementEMRProcess ImprovementDefect ManagementDocumentation
Performed quality reviews for healthcare claims processing and denial management and supported process optimization initiatives. Improved COB accuracy and reduced claim rework through structured quality analysis and process improvement.
Quality AssuranceClaims ProcessingDenial ManagementProcess ImprovementCOB
Supported Revenue Cycle Management, payment recovery, compliance, and reporting as a healthcare claims SME. Collaborated with providers, payers, and operations teams to resolve complex reimbursement issues and performed data analysis using Tableau, Power BI, Excel, and SQL.
Revenue Cycle ManagementPayment RecoveryComplianceReportingTableauPower BIExcelSQL
Supported Accounts Receivable, Subrogation, Workers' Compensation, and Denial Management as a healthcare claims SME. Identified reimbursement opportunities and supported recovery outcomes and payer compliance initiatives.
Accounts ReceivableSubrogationWorkers’ CompensationDenial ManagementReimbursementCompliance
Completed an M.B.A. in Management with First Division.
Completed a B.B.A. / B.M.S. in Management with a grade of 7/10.