Sonali S
Chennai
Summary
Detail-oriented professional skilled in ICD-10 coding and claims adjudication. Proven track record in ensuring compliance and accuracy in medical billing processes. Specializing in Healthcare and Marketplace Audit (3+ years, Cognizant), with expertise in claims adjudication, coding validation, insurance review, and marketplace compliance auditing. Awarded Best Employee of the Year (2023 and 2024). Seeking day-shift roles in Medical Coding, Quality Analyst, RCM Audit, or Healthcare Operations.
Overview
4
4
years of professional experience
Work History
Senior Process Executive
Cognizant Technology Solutions
Chennai
03.2022 - Current
- Process and adjudicate claims with coding standards and payer rules.
- Validate patient data, insurance eligibility, and documentation accuracy.
- Handle all claim types using the CWS audit tool with consistent quality.
- Review marketplace product listings for policy compliance.
- Identify listing violations, pricing issues, restricted items, and fraud.
- Accurately assign ICD-10, CPT, and HCPCS codes to medical diagnoses and procedures for claims submitted by health care providers.
- Managing a claim form that starts through to settlement, making decisions on the extent and validity of a claim, and checking for any potentially fraudulent activity.
- Ensure compliance with all relevant coding guidelines, and industry standards, as well as to improve claims submission.
- Provide support to the billing department to resolve claim denials and resubmit claims with corrected coding.
Education
B.com and M.com -
B.S Matriculation Higher Secondary School (2017)
ChennaiSkills
- Claims processing
- ICD-10 coding
- CPT coding
- HCPCS coding
- Claim adjudication
- Medical billing
- Data analytics (SQL, Power BI)
- MS Office, MS Excel
- Typewriting lower and upper
Languages
English
Advanced (C1)
C1
Tamil
Proficient (C2)
C2
Hindi
Upper Intermediate (B2)
B2
Bengali
Elementary (A2)
A2
Timeline
Senior Process Executive
Cognizant Technology Solutions
03.2022 - Current
B.com and M.com -
B.S Matriculation Higher Secondary School (2017)