Open To Work
Maria Soosai Antoni Priyanka T
Chennai
Summary
Highly experienced Healthcare Operations and Risk Adjustment Coding leader with 13+ years of experience managing medical coding projects, operational delivery, and large coding teams within the healthcare solutions industry. Proven ability to drive operational excellence, maintain regulatory compliance, and deliver projects within defined productivity and quality SLAs. Experienced in leading cross-functional teams, optimizing coding workflows, and implementing process improvements that enhance efficiency and client satisfaction. Recognized for strong team leadership, stakeholder communication, and performance management in high-volume healthcare operations.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Manager – Risk Adjustment Coding
Optum Health & Technology (Formerly Episource)
Chennai, India
02.2023 - Current
- Directed large-scale Risk Adjustment coding operations for the WellMed client, managing Single Attestation and Retrospective Chart Review projects for Medicare Advantage populations while ensuring compliance with CMS-HCC guidelines.
- Led end-to-end project execution, driving operational delivery within defined Service Level Agreements (SLA) for productivity, turnaround time, and coding quality.
- Acted as the primary client point of contact, managing stakeholder communications and facilitating weekly operational review meetings to discuss performance metrics, quality outcomes, and workflow improvements.
- Supervised a large operational structure of 100+ medical coders (indirect reports) and team leaders (direct reports), ensuring consistent productivity, quality adherence, and regulatory compliance with CMS risk adjustment coding standards.
- Implemented structured coaching, mentoring, and performance monitoring programs, strengthening coder competency and improving overall coding accuracy and productivity.
- Designed and implemented a standardized audit feedback mechanism, translating complex audit findings into actionable insights that improved coder understanding of documentation and compliance requirements.
- Established and monitored coding quality metrics and performance dashboards, enabling proactive tracking of audit results and sustaining high accuracy standards across teams.
- Led project onboarding and operational setup, including EMR access coordination, application provisioning, and user access management to ensure seamless project readiness.
- Generated and presented weekly operational performance reports, including EMR productivity analytics, access utilization insights, and project updates for internal leadership and client stakeholders.
- Tracked forecasted versus actual productivity metrics, enabling proactive workload distribution, operational efficiency, and resource optimization.
- Partnered with cross-functional teams (IT, compliance, operations, and client stakeholders) to ensure smooth project launches, scalable workflows, and adherence to healthcare data security standards.
- Designed a structured ramp-up program for trainee coders, including productivity benchmarks, quality checkpoints, and continuous feedback, enabling trainees to successfully complete probation and transition to full productivity within defined timelines.
Group Team Leader / Team Leader – Risk Adjustment
Episource (Acquired by Optum)
Chennai
04.2017 - 01.2023
- Supervised day-to-day coding operations by working closely with medical coders, monitoring daily productivity and quality performance to ensure adherence to project targets and CMS risk adjustment coding guidelines.
- Provided individual coaching, mentoring, and performance counselling to coders, supporting goal setting and development plans aligned with annual performance objectives.
- Reviewed client audit feedback reports and translated findings into actionable guidance, conducting team education sessions to improve documentation interpretation and coding accuracy.
- Implemented strategic audit allocation processes to strengthen quality oversight and improve overall project accuracy.
- Conducted coding result validation and quality checks prior to final submission, ensuring accurate data capture and compliance with client requirements.
- Managed the upload and submission of validated coding results into the client platform, ensuring timely delivery and data integrity.
- Supported continuous project improvement initiatives, identifying workflow gaps and implementing corrective actions to enhance team productivity and quality outcomes.
- Collaborated with project managers and quality teams to maintain SLA commitments for turnaround time, productivity, and coding accuracy.
- Delivered training on client-specific guidelines, coding updates, and CMS regulatory changes, ensuring the team remained compliant with evolving coding standards.
Medical Coder - Quality Assurance
Episource (Acquired by Optum)
Chennai, India
03.2013 - 03.2017
- Reviewed and coded medical charts for risk adjustment projects, ensuring accurate ICD-10 code assignment in accordance with CMS guidelines and client-specific coding standards.
- Maintained ~99% coding accuracy while consistently meeting daily chart productivity targets in high-volume chart review environments.
- Progressed into a Quality Assurance role, performing detailed audits of coded charts to validate documentation support, coding accuracy, and regulatory compliance.
- Provided structured audit feedback and coaching to coders to address quality gaps and improve overall team accuracy.
- Mentored junior coders and underperforming team members using Side-by-Side (SBS) coaching techniques to strengthen coding fundamentals and improve audit outcomes.
- Developed training materials and educational resources to support coder development and reinforce client-specific coding requirements.
- Conducted team education sessions on new client guidelines, documentation requirements, and coding updates to ensure consistent adherence to standards.
- Collaborated with operations and quality teams to identify recurring coding errors and implement corrective training initiatives to improve project quality.
Education
Bachelor of Technology - Biotechnology
Kalasalingam University
Srivilliputhur, India05-2012
Certificate - Certificate Programme in Project Management
Indian Institute of Technology
05-2025
Skills
- Risk Adjustment Coding (CMS-HCC)/ ICD-10-CM
- Retrospective Chart Review/Single Attestation Coding
- Healthcare Operations Management
- Client Relationship Management
- EMR Workflow Management
- Team Leadership & Performance Coaching
- Production & SLA Management
- Quality Assurance and Risk Management
- Process Optimization
- Strategic Planning and Execution
Certification
- CPC (Certified Professional Coder) – AAPC
- CRC (Certified Risk Adjustment Coder) – AAPC
Timeline
Manager – Risk Adjustment Coding
Optum Health & Technology (Formerly Episource)
02.2023 - Current
Group Team Leader / Team Leader – Risk Adjustment
Episource (Acquired by Optum)
04.2017 - 01.2023
Medical Coder - Quality Assurance
Episource (Acquired by Optum)
03.2013 - 03.2017
Bachelor of Technology - Biotechnology
Kalasalingam University
Certificate - Certificate Programme in Project Management
Indian Institute of Technology