Pooja Latha Athota
Dublin
Summary
Healthcare Revenue Cycle and Compliance Professional with over five years of experience in medical coding, claims analysis, risk adjustment, and healthcare operations across payer and provider environments. CPC-certified specialist with strong expertise in ICD-10-CM, CPT, and HCPCS coding, reimbursement accuracy, denial management, and regulatory compliance. Master of Healthcare Administration with ongoing doctoral studies in Business Management, bringing strategic insight into healthcare financial performance and operational improvement. Proven ability to conduct coding audits, analyze claims data, support revenue optimization initiatives, and collaborate with cross-functional teams to enhance workflow efficiency. Seeking remote opportunities as a Revenue Cycle Analyst, Healthcare Analyst, Risk Adjustment Analyst, or Coding Auditor.
Diligent health analyst with solid foundation in wealth analysis and history of contributing to financial planning initiatives. Applied analytical expertise to optimize investment strategies, enhancing client portfolio performance. Demonstrated proficiency in data interpretation and client relationship management.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Health Analyst
HS Solutions, Inc.
San Ramon, CA
12.2024 - Current
- Analyze large volumes of healthcare claims data to identify revenue leakage, underpayments, and reimbursement inconsistencies.
- Perform detailed ICD-10-CM, CPT, and HCPCS code validation to ensure compliance with CMS, Medicare Advantage, and commercial payer policies.
- Conduct risk adjustment chart reviews to validate HCC capture and ensure accurate RAF score documentation.
- Identify coding trends, documentation gaps, and compliance risks through structured audits.
- Support denial management by performing root cause analysis and recommending corrective action plans.
- Collaborate with providers, billing teams, and compliance departments to resolve claim discrepancies.
- Prepare monthly KPI dashboards tracking denial rates, clean claim rates, AR days, and reimbursement performance.
- Perform payer contract analysis to ensure accurate reimbursement calculations.
- Support pre-bill and post-bill coding audits to reduce compliance risk exposure.
- Participate in internal and external audit readiness initiatives.
- Utilize Excel (pivot tables, VLOOKUP, data validation) to analyze reimbursement and operational trends.
- Maintain HIPAA compliance and ensure secure handling of PHI in remote work environments.
Senior Medical Coder
Clarus RCM
Hyderabad, India
07.2021 - 11.2022
- Assigned accurate ICD-10-CM, CPT, and HCPCS codes across multi-specialty services, maintaining 98%+ coding accuracy.
- Conducted pre-bill and retrospective coding audits to ensure regulatory and payer compliance.
- Reviewed E/M coding levels to ensure appropriate documentation and reimbursement accuracy.
- Identified coding-related denials and collaborated with AR teams to support appeals and overturn underpayments.
- Performed risk adjustment coding reviews to validate chronic condition documentation and HCC accuracy.
- Monitored coding trends and provided feedback to providers to improve documentation specificity.
- Assisted in internal compliance audits and supported corrective action implementation.
- Ensured compliance with CMS, NCCI edits, and payer-specific billing guidelines.
- Trained junior coders on coding updates and documentation standards.
- Supported revenue cycle workflow improvements to reduce claim rejection rates.
- Reviewed and coded medical records for accuracy and compliance with regulatory standards.
- Collaborated with healthcare professionals to resolve coding discrepancies and improve documentation quality.
Health Associate
Wipro Limited
Hyderabad, India
06.2019 - 06.2021
- Processed medical claims and conducted detailed medical record abstraction for payer clients.
- Reviewed claims for accuracy, eligibility, and coverage validation prior to submission.
- Analyzed denial trends and assisted in implementing workflow improvements to reduce recurring issues.
- Supported reconciliation of payments, EOB reviews, and identification of reimbursement discrepancies.
- Conducted quality assurance reviews to maintain compliance with payer and regulatory standards.
- Collaborated with cross-functional teams to improve turnaround time and operational efficiency.
- Assisted in risk adjustment documentation reviews to support Medicare Advantage clients.
- Maintained detailed audit trails and documentation for compliance tracking.
- Coordinated health program initiatives to enhance community wellness and engagement.
- Streamlined data collection processes, improving accuracy in health assessments and reporting.
Education
Master of Healthcare Administration - Health Administration
University of New Haven
Connecticut12-2025
Bachelor of Science - Pharmacy
Sarojini Naidu Vanita Pharmacy Mahavidyalaya
India06-2019
Ph.D. - Business Management
Wayland Baptist University
Texas City, TX01-2030
Skills
- Revenue Cycle Management (RCM)
- Denials Management & Appeals
- Healthcare Reimbursement Analysis
- Risk Adjustment & HCC Coding
- ICD-10-CM, CPT, HCPCS Coding
- Claims Data Analysis
- AR & Denial Trend Reporting
- CMS & Payer Compliance
- Revenue Integrity
- Excel-Based Reporting & KPI Tracking
Certification
- Certified Professional Coder (CPC) – AAPC
- Certified in Pharmacovigilance and Clinical Trial Programs
Timeline
Health Analyst
HS Solutions, Inc.
12.2024 - Current
Senior Medical Coder
Clarus RCM
07.2021 - 11.2022
Health Associate
Wipro Limited
06.2019 - 06.2021
Master of Healthcare Administration - Health Administration
University of New Haven
Bachelor of Science - Pharmacy
Sarojini Naidu Vanita Pharmacy Mahavidyalaya
Ph.D. - Business Management
Wayland Baptist University