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, India01.2008
Skills
PICTS (Payment Integrity case tracking system)
EncoderPro
IDRS (Image document retrieval system)
Doc360
DocDna
PEGA
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