NIVETHA S
Senior Claims Examiner
Chennai
Summary
Detail-oriented and certified Healthcare & Medical Coding Professional with 4+ years of experience in US healthcare claims processing, adjudication, and compliance. Skilled in ICD-10-CM, CPT, and HCPCS coding systems with a strong foundation in medical terminology and payer guidelines. Adept at ensuring coding accuracy, process efficiency, and quality standards across RCM operations. Currently advancing expertise through formal medical coding training at Achievers Spot Medical Coding Academy.
Overview
12
12
years of professional experience
3
3
Certifications
2
2
Languages
Work History
HCC Coder
Calibrated Healthcare Network
Delhi , India
06.2025 - Current
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
Claims Examiner II
Calibrated Healthcare
Delhi , India
01.2024 - 05.2025
- Review and process US healthcare claims ensuring coding and payer compliance.
- Validate diagnosis and procedure codes as per ICD-10-CM, CPT, and HCPCS standards.
- Collaborate with quality and audit teams to maintain 99%+ accuracy.
- Support process efficiency through continuous performance monitoring and feedback.
- Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
Telemarketing Executive
Casagrand Pvt. Ltd.
02.2022 - 12.2023
- Conducted outbound calls for lead generation and project promotion.
- Recorded client data and follow-ups using CRM tools for conversion tracking.
- Consistently exceeded monthly targets through persuasive communication.
Career Break
Personal and Child Care Responsibility
01.2015 - 01.2021
- Took a planned career break to focus on family care while maintaining continuous self-learning through online healthcare courses.
- Stayed updated on US healthcare processes, payer regulations, and RCM workflows.
- Resumed professional development with a focus on transitioning into medical coding.
Senior Process Associate
Cognizant Technology Solutions
10.2013 - 07.2015
- Processed healthcare claims and verified insurance documentation accuracy.
- Ensured compliance with client specifications, coding, and HIPAA regulations.
- Identified data discrepancies and contributed to process improvement initiatives.
Education
Bachelor of Computer Applications - BCA
Madras University
01.2013
12th Grade - undefined
Tamil Nadu State Board
01.2010
10th Grade - undefined
Tamil Nadu State Board
01.2008
Skills
Medical Coding (ICD-10-CM, CPT, HCPCS)
US Healthcare Claims Adjudication
Denial Management & Compliance
Healthcare Process Improvement
Quality Analysis & Audit Support
EHR / EMR Data Validation
Team Collaboration & Client Communication
MS Office & CRM Tools
Certification
Medical Coding – Basic Course (2025)
Interests
Listening to Music, Drawing, Craftwork
Timeline
HCC Coder
Calibrated Healthcare Network
06.2025 - Current
Claims Examiner II
Calibrated Healthcare
01.2024 - 05.2025
Telemarketing Executive
Casagrand Pvt. Ltd.
02.2022 - 12.2023
Career Break
Personal and Child Care Responsibility
01.2015 - 01.2021
Senior Process Associate
Cognizant Technology Solutions
10.2013 - 07.2015
Bachelor of Computer Applications - BCA
Madras University
12th Grade - undefined
Tamil Nadu State Board
10th Grade - undefined
Tamil Nadu State Board