Summary
Overview
Work History
Education
Skills
Accomplishments
Certification
Languages
Websites
Affiliations
Timeline
Generic
Aashna Mourya

Aashna Mourya

Pune

Summary

Dedicated Quality Assurance Analyst (CPC certified) with 5 and a half years of experience in the US healthcare industry, specializing in clinical validation. Proficient in evaluating coding and medical document accuracy, compliance with industry standards, and adherence to regulatory requirements. Adept at developing and implementing quality assurance procedures to optimize clinical coding processes and minimize errors. Experienced end to end claims audit, managing employee coaching sessions for growth propositions and community programs.

Overview

6
6
years of professional experience
1
1
Certification

Work History

Quality Assurance Analyst

Cotiviti India Private Limited
Pune
03.2023 - Current
  • Conducting comprehensive audits of clinical validation processes to ensure accuracy, consistency, and compliance with regulatory requirements.
  • Developing and implementing quality assurance procedures, including coding guidelines, standards, and protocols, to enhance efficiency and minimize errors.
  • Analyzing coding data and audit findings to identify trends, patterns, and areas for improvement, providing actionable insights to management.
  • Preparing detailed reports and documentation on audit results, including recommendations for corrective actions and process enhancements.
  • Facilitating training sessions for clinical staff to enhance their understanding of coding and validation guidelines, compliance requirements, and quality assurance protocols.

Quality Auditor

Optum Global Solutions
Noida
11.2021 - 02.2023
  • Being associated with the payer side of US health insurance business, the primary job function is the identification of any fraudulent billing patterns.
  • Auditing the claims reviewed by the team to avoid underpayment and/or over-payment.
  • Managing employee coaching sessions and providing them feedbacks.

Clinical Investigator

Optum Global Solutions
Noida
11.2018 - 10.2021
  • Identifying discrepancies between medical records and billed services for complex and high value claims by identifying up-coding, unbundling, duplication and misinterpretation of services.
  • Updating provider's specific pattern billing entries in TIPS for future reference for other team members.
  • Utilizing medical expertise, knowledge of CPT/diagnosis codes, CMC guidelines along with referring to client specific guidelines and member policies while performing clinical review.
  • Working on various claim types (CMS 1500 & UB 04).

Education

Internship -

Aditya Birla Memorial Hospital
Pune
05-2018

Bachelor of Physiotherapy -

Amity University
Noida
06-2017

Skills

  • Clinical Coding Validation
  • Quality Assurance Procedures
  • Compliance and Regulatory Standards
  • Healthcare Industry Knowledge
  • Documentation and Reporting
  • Team Collaboration and Leadership
  • Problem-Solving and Decision-Making
  • Attention to Detail

Accomplishments

  • Employee of the Quarter

Certification

  • Certified Professional Coder (CPC)
  • Currently pursuing Lean Six Sigma (LSSGB)

Languages

Hindi
First Language
English
Proficient (C2)
C2
German
Intermediate (B1)
B1

Websites

Affiliations

  • Outdoor Recreation
  • Learning new Languages
  • Trekking
  • Travelling

Timeline

Quality Assurance Analyst

Cotiviti India Private Limited
03.2023 - Current

Quality Auditor

Optum Global Solutions
11.2021 - 02.2023

Clinical Investigator

Optum Global Solutions
11.2018 - 10.2021

Internship -

Aditya Birla Memorial Hospital

Bachelor of Physiotherapy -

Amity University

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Aashna Mourya