Summary
Overview
Work History
Education
Skills
Certification
Interests
Disclaimer
Timeline
Generic
Aswathy Ashok

Aswathy Ashok

Provider Appeals & Clinical Chart reviewer
Mahadevapura

Summary

To pursue a challenging and rewarding career by being constructive and innovative in my efforts and to make myself competent enough for performing all my tasks independent responsibility as well as in a team in the organization to move ahead in my life and add to the growth of the organization.

Overview

11
11
years of professional experience
7
7
Certifications
1
1
Language

Work History

Provider Appeals

Accenture
03.2022 - 08.2024
  • Company Overview: Health Clinical Analyst.
  • Project - Cigna
  • Clinical decision-making for multispecialty codes and surgeries, evaluation and management notes, DME, fraud investigation analysis for waste and error, and denial management using EHR at the payer side of insurance according to Medicare service policies for the claimed insurance billing services of the U.S.
  • DME, fraud investigation analysis for waste, error, and denial management using EHR at the payer side of insurance, according to Medicare service policies for the claimed insurance billing services of the U.S.
  • Healthcare setup and systems.

Appeals Analyst

OPTUM GLOBAL SOLUTIONS
10.2019 - 10.2021
  • Company Overview: Clinical Appeals Analyst
  • Prevent the payment of potentially fraudulent and/abusive claims utilizing medical expertise, knowledge.
  • RPA: working claims/Denial management on RPA
  • Subsequent and Appeals Review of claims
  • CPT/ICD-10 diagnosis codes, CMS guideline along with referring to client specific guidelines and member policies.
  • Knowledge of US Health Care and coding. Attention to detail & Quality focused.
  • Good Analytical & Comprehension skills.
  • Expertise in review part of medical records in Pre-Pay claims of Medicare Employee & Individual plan such as First review, Reconsideration claims.

Case Management

Primera Medical Technologies
06.2016 - 01.2018
  • Company Overview: Process Executive - Executive - Core Measures.
  • Worked on diagnostic codes and E&M codes.
  • Sepsis and stroke live chart analysis.

Staff Nurse

Apollo Hospitals Jubilee hills
08.2013 - 02.2016
  • CTICU Department as a Staff nurse.
  • Proficient in the use of Defibrillator, Ventilator cardiac Monitor, Syringe pump, IABP, NIBP, ABG, LAB INVESTIGATION RESULTS

Education

Bachelor of Science -

Sri Vignan Nursing Academy College
Kadiri, India
04.2001 -

Intermediate -

N.S.S.H.S.S Lakkattour
Kottayam, India
01.2008

Skills

PICTS (Payment Integrity case tracking system)

Certification

NCLEX RN Passed 2025-04-30

Interests

Hobbies: Cooking

Reading books

Yoga

Disclaimer

I hereby declare that the information given above is true to the best of my knowledge. Date: 2025-06-28, Place: Bengaluru. Aswathy Ashok.

Timeline

Provider Appeals

Accenture
03.2022 - 08.2024

Appeals Analyst

OPTUM GLOBAL SOLUTIONS
10.2019 - 10.2021

Case Management

Primera Medical Technologies
06.2016 - 01.2018

Staff Nurse

Apollo Hospitals Jubilee hills
08.2013 - 02.2016

Bachelor of Science -

Sri Vignan Nursing Academy College
04.2001 -

Intermediate -

N.S.S.H.S.S Lakkattour

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Aswathy AshokProvider Appeals & Clinical Chart reviewer