Suguna Muthiah
Chennai
Summary
Seasoned healthcare operations leader with over 20 years of progressive experience in encounter data management, regulatory compliance, and payer operations within the U.S. healthcare ecosystem. Expert in CMS encounter submissions for Medicaid and Medicare Advantage programs (CAID & CARE), with a proven track record in optimizing submission accuracy, automation, and governance frameworks. Known for leading large, cross-functional teams and managing multi-client portfolios using Facets and industry-standard EDI layouts (837, PACDR, RAPS, EDPS). Adept at driving transformation, audit readiness, and regulatory alignment across payer organizations.
Dynamic Deputy General Manager with extensive experience in managing CMS encounter submissions and regulatory compliance. Skilled in client relationship management and data analytics, consistently achieving high performance metrics and driving continuous improvement across operational processes.
Overview
21
21
years of professional experience
Work History
Deputy General Manager
Cognizant Technology Solutions
Chennai
01.2022 - Current
- Directed enterprise-scale CMS encounter operations across multiple payer clients including HCSC, CCA, OHP, and VNS, ensuring full regulatory compliance and timely data submission.
- Spearheaded process automation and analytics frameworks, improving first-pass acceptance rates and reducing rejections through root cause elimination and data integrity controls.
- Served as the primary client partner and regulatory SME, translating CMS/state mandates into scalable delivery frameworks across global teams.
- Championed Facets-based encounter management, integrating business and IT workflows for Medicaid and Medicare Advantage submissions.
- Managed high-performing teams (onsite and offshore), mentoring leaders in operations, quality, and client delivery excellence.
- Developed audit and compliance playbooks aligned with CMS and PACDR guidelines, ensuring zero non-compliance findings during audits.
- Drove continuous improvement initiatives that enhanced data accuracy, regulatory transparency, and operational scalability.
- Achieved 99% SLA compliance for encounter data submissions and acceptance for a leading Medicare client, exceeding contractual quality and timeliness benchmarks.
- Successfully managed multiple client implementations including VNS, CCA, and VCMAX, ensuring accurate CMS encounter submissions aligned with federal and state requirements.
- Streamlined submission processes through workflow automation and performance monitoring, resulting in improved accuracy and reduced rework.
- Led governance and compliance reviews to ensure audit readiness and adherence to CMS and PACDR standards.
- Recognized for cross-functional leadership and delivery excellence, consistently meeting or surpassing SLA and operational KPIs across client portfolios.
- Oversaw project budgets, ensuring adherence to financial guidelines and constraints.
- Facilitated training sessions for staff to enhance skills and knowledge sharing.
- Coordinated resource allocation to optimize team performance on multiple projects.
- Developed strategic initiatives to improve operational efficiency across departments.
- Managed client relationships, ensuring clear communication and project alignment.
- Led cross-functional teams to enhance project delivery at Cognizant Technology Solutions.
- Streamlined processes by implementing best practices in project management methodologies.
- Supervised team members, established performance goals, provided feedback, and conducted performance reviews.
- Identified areas of improvement in operational processes and developed solutions accordingly.
- Established strong relationships with internal teams as well as external partners, suppliers, vendors.
- Coordinated employee performance management and provided feedback on job duties and responsibilities.
- Analyzed financial data to identify potential opportunities for cost savings or revenue generation.
- Interpreted regulations, laws and rules to appropriately develop processes and procedures.
- Coordinated with external vendors to obtain materials at competitive prices while meeting quality requirements.
- Monitored progress against key performance indicators to evaluate effectiveness of operational activities.
- Facilitated communication between different departments within the organization for effective coordination.
- Prepared reports on various aspects of organizational operations for senior management review.
- Reviewed existing policies and procedures to ensure compliance with applicable laws and regulations.
- Oversaw implementation of corrective actions to improve efficiency and reduce waste.
- Resolved employee issues in a timely manner by providing guidance and counseling as needed.
- Contributed towards organizational growth by identifying new markets and opportunities for expansion.
- Guided management and supervisory staff to promote smooth operations.
- Recruited, interviewed and hired qualified staff for open positions.
Manager - Encounter Reporting
Cognizant Technology Solutions
Scranton
08.2017 - 10.2020
- Led cross-functional teams to enhance project delivery and operational efficiency.
- Developed strategic plans to align technology solutions with client business needs.
- Managed stakeholder communications to ensure project alignment and expectations.
- Facilitated team meetings to drive collaboration and resolve project challenges.
- Provided leadership during times of organizational change or crisis situations.
- Developed and implemented strategies to increase customer satisfaction and loyalty.
- Conducted regular meetings with staff to discuss progress and identify areas of improvement.
- Assessed team member's skillsets and assigned tasks accordingly for optimal efficiency.
- Created monthly reports for senior management summarizing operational performance metrics.
Business Analyst
Cognizant Technology Solutions
Chennai
08.2004 - 07.2017
- Analyzed business requirements to identify solutions and improve processes.
- Collaborated with cross-functional teams to gather and document project specifications.
- Facilitated workshops to elicit stakeholder feedback and validate project objectives.
- Managed project timelines and coordinated deliverables across multiple departments.
- Created process documentation to ensure consistency and compliance with standards.
- Supported user acceptance testing by coordinating feedback and identifying system issues.
- Managed projects and served as primary liaison between client and multiple internal groups to clarify goals and meet standards and deadlines.
- Collaborated with stakeholders across departments to define requirements for new projects.
- Analyzed existing systems and processes to identify areas of improvement.
- Identified gaps between current state and desired future state operations.
- Facilitated brainstorming sessions with cross-functional teams for problem solving activities.
- Designed test plans, scenarios, scripts, cases, and results matrices to validate system functionality.
- Gathered feedback from end users regarding usability issues related to applications or systems.
- Identified and analyzed user requirements, procedures and processes to develop optimization strategies.
- Drafted functional specifications documents outlining project scope, objectives and deliverables.
- Created detailed process flows and user stories to document system requirements and design solutions.
- Evaluated business processes for improvement opportunities through automation or streamlining.
- Translated user needs into actionable items that could be addressed by IT teams.
- Developed reports using SQL queries to track progress against key performance indicators.
- Mapped and documented interfaces between legacy and new systems.
- Conducted detailed business analysis, outlining problems, opportunities, and solutions for a business.
Education
Bachelor of Engineering (B.E.) - Computer Science and Engineering
University of Madras
Skills
- CMS Encounter Submissions (Medicaid & Medicare Advantage)
- Facets Platform & Healthcare Data Integration
- Regulatory Compliance & Audit Governance
- EDI Transaction Layouts – 837, PACDR, RAPS, EDPS
- Process Automation & Operational Excellence
- Client Relationship Management & Stakeholder Engagement
- Performance Metrics & Quality Frameworks
- Team Leadership
- Mentoring
- Cross-Functional Delivery
- Encounter management
- Process automation
- Data analytics
- CMS framework development
- Stakeholder communication
- Team leadership
Key Projects And Achievements
- Achieved 99% SLA compliance for encounter data submissions and acceptance for a leading Medicare client, exceeding contractual quality and timeliness benchmarks.
- Successfully managed multiple client implementations including VNS, CCA, and VCMAX, ensuring accurate CMS encounter submissions aligned with federal and state requirements.
- Streamlined submission processes through workflow automation and performance monitoring, resulting in improved accuracy and reduced rework.
- Led governance and compliance reviews to ensure audit readiness and adherence to CMS and PACDR standards.
- Recognized for cross-functional leadership and delivery excellence, consistently meeting or surpassing SLA and operational KPIs across client portfolios.
Professional Highlights
- 20+ years with Cognizant, demonstrating sustained career growth and trusted client partnership.
- Recognized for transformational leadership in encounter operations and compliance innovation.
- Proven success managing multi-state encounter submissions across CMS-regulated programs.
Languages
English
Proficient
C2
Tamil
Proficient
C2
Timeline
Deputy General Manager
Cognizant Technology Solutions
01.2022 - Current
Manager - Encounter Reporting
Cognizant Technology Solutions
08.2017 - 10.2020
Business Analyst
Cognizant Technology Solutions
08.2004 - 07.2017
Bachelor of Engineering (B.E.) - Computer Science and Engineering
University of Madras