MADHUMANTI DAS
Summary
Healthcare Claims Auditor with 5+ years of experience auditing over 2000+ claims per month for compliance with HIPAA, Medicare & Medicaid regulations while maintaining 98% accuracy. Skilled in payment integrity reviews, medical records analysis, claims validation, internal auditing. Possess a unique combination of postgraduate qualifications in Information Technology and Chemistry, enabling strong analytical and clinical data interpretation capabilities. Proven ability to strengthen compliance programs through the development of audit procedures and process improvement initiatives. Experienced in mentoring junior auditor and collaborating with cross-functional teams to enhance operational efficiency.
Work History
Claims Audit Assistant
4 Years 3 Months- Audited 2,000+ healthcare claims monthly, maintaining 98% accuracy against HIPAA, CMS regulations, and client-specific compliance guidelines.
- Reviewed 500+ claims weekly with meticulous attention to clinical documentation, identifying discrepancies and escalating system inefficiencies to management — directly contributing to reduced processing delays.
- Developed a comprehensive training manual for new claims audit assistants, standardizing audit procedures and ensuring consistent compliance application across the team.
- Mentored and trained new team members on audit protocols, compliance standards, and documentation best practices.
- Prepared detailed audit reports, findings summaries, and compliance dashboards for management review.
- Collaborated with cross-functional teams to optimize audit workflows, resolve compliance gaps, and uphold client and regulatory standards.
- Maintained high-security integrity in claims and medical record reviews, ensuring zero-tolerance compliance with data protection requirements.
Process Associate
1 Year 2 Months- Managed end-to-end customer query resolution while adhering to strict quality benchmarks and service delivery timelines.
- Supported quality control initiatives to maintain consistency and accuracy across all operational deliverables.
- Collaborated with cross-functional teams to identify root causes of recurring issues and implement process improvements.
Education
Master of Science - Information Technology
Master of Science - Chemistry
Bachelor of Science
Skills
Certification
Quality Assurance and Management in Healthcare