Headline

Healthcare Operations | Clinical Ops Analyst | Medicaid/VA/Commercial Billing Audits | RCM | Clinical Documentation & EHR Compliance | AI Workflow Design (Ops) | HIPAA

About

I work at the intersection of healthcare revenue cycle auditing, clinical quality compliance, and applied AI. In my current role in Audit Operations, I own the end-to-end audit intake lifecycle for US home care providers billing Medicaid, VA, and commercial payers — provider onboarding, remittance data collection across payer portals (Optum Pay, State Medicaid/MMIS) and AMS/EHR platforms like WellSky, discrepancy resolution, and audit file handoff to analysts, while sustaining 100% intake accuracy against a ≥95% target. What makes my work distinctive is the AI layer: I design and validate Claude-powered workflows for remittance parsing, claim categorization, and audit file generation, then lead internal AI enablement — training teammates on prompt engineering and Claude-in-Excel, and authoring a reusable team prompt handbook. Before this, I worked in Care Coordination at a US healthcare operations company, monitoring clinical documentation within EHR systems for SOP and HIPAA compliance, and briefly onboarded and led a second initiative validating clinical notes and ICD codes against patient requirements, maintaining the HIS/LIS system, and setting up SOPs from scratch for a new quality-analysis workflow. Across both roles, my focus stays the same: patient-safety-first documentation accuracy, audit readiness, and using AI thoughtfully to make clinical and billing operations faster without cutting corners on compliance. Core focus areas: • Medicaid, VA & commercial payer billing audits • Remittance advice (RA/ERA) analysis & payment reconciliation • Clinical documentation, ICD code & EHR/HIS-LIS validation • AI-assisted workflow design & prompt engineering (Claude) • SOP development & audit-readiness compliance • Cross-functional escalation management & team training Open to connecting with people working in healthcare ops, RCM audits, clinical quality, or applied AI in operations.

Location

Bengaluru

AI stack

claude

gemini

Canva Magic Studio

ChatGPT

Microsoft Copilot

Work experience

Audit Intake Coordinator at Eastvantage, Jul 2026 - Present · 4 mos, Bengaluru, Manage end-to-end audit intake for US home care providers billing Medicaid, VA, and commercial payers, covering provider onboarding, audit file preparation, discrepancy resolution, and analyst handoff while maintaining 100% intake accuracy against a ≥95% target and HIPAA-compliant, audit-ready records. Analyse remittance advices (RA/ERA) and invoice data across multiple payer portals (Optum Pay, State Medicaid/MMIS) and AMS/EHR systems (WellSky) to reconcile billed vs. paid claims, identify missing payments, and surface critical audit findings. Design and validate AI-enabled audit workflows using Claude for remittance parsing, claim categorization, and audit file generation, reducing manual reconciliation effort and improving reporting accuracy. Support issue governance and escalation management by documenting findings in HubSpot CRM, tracking action items, and coordinating same-day escalations with Audit Managers, Account Managers, and Finance. AI enablement across the team by conducting Claude training sessions on prompt engineering and Claude-in-Excel workflows, and authoring a reusable prompt handbook to standardize audit-specific AI usage.

Project Associate - Care Coordination at Cojective Labs, Mar 2025 - Jul 2026 · 1 yr 5 mos, Ahmedabad, Project 1 – Care Coordination for Care Management Plans (CCM/RPM) & Compliance Monitoring: Handled the patients' pipeline for care plans & conducted compliance monitoring of clinical documentation within EHR systems to ensure adherence to SOPs, HIPAA standards, and quality frameworks, maintaining audit-ready records for smooth billing process. Analysed documentation and data trends to identify gaps and operational risks, supporting root cause analysis and corrective action follow-up. Supported issue governance by documenting findings, tracking action items, and collaborating with cross-functional stakeholders. Used Excel and AI-enabled tools to generate data-driven insights and strengthen reporting accuracy. Project 2 – Clinical Quality Analysis of Lab Orders (onboarded & initiated): Onboarded a new clinical quality analysis initiative for lab orders, standing up the project's SOPs and documentation structure from scratch. Validated clinical notes and ICD codes against patient requirements to confirm lab orders were clinically justified. Maintained the HIS/LIS system with QA updates to keep lab order data accurate. Investigated test-ordering accuracy, flagging and reviewing any additional or unrequired tests against clinical need.

Education

Master of Science - MS, Microbiology, bangalore university

Bachelor of Science - BS, Microbiology, the assam royal global University