Kaveri Gharge
Summary
I am a BAMS Graduate with over 10 years of experience in Healthcare domain including 6+ years experience in US Healthcare. Excellent analytical, communication, decision-making and interpersonal skills, always willing to work in challenging and cross platform environments. Demonstrated understanding of US Healthcare billing, Claims adjudication, Research on CMS Updates, Client communication, Data Analysis, Quality Analysis (QA) and Team Management.
Overview
10
10
years of professional experience
Work History
Team Lead Clinical Content Operations
Cotiviti Pvt Ltd
01.2019 - 11.2023
Project Management
- Coordinated project timelines and tasks ensuring timely project delivery
- Participated in requirement gathering, sprint plannings, UAT Testing, demonstrations and implementations
- Worked closely with the product development team for process enhancements and automation of existing processes
- Actively involved in new platform development of Cotiviti
- Owned multiple internal processes/projects and handled their end to end processing
- Worked on system integration across platforms with innovation of new processes like CPT-ICD LINK
- Involved in the User Acceptance testing UAT to check the reliability for end users.
Subject Matter Expert
- Developed adjudication concepts for DME (Durable Medical Equipment), QOC and Max Units policies including Medicare, Medicaid and Commercial LOB's to support payment accuracy and correct medical coding.
- Assist Client's (Payers) query related to Medicare claims on daily basis
- Analysis and Interpretation of Medicare guidelines to maintain the existing logics/concepts on data base
- Introduced new concepts for different policies based on in-depth research of CMS processes like LCD and transmittal
- Process ownership of DME Fee schedule, CMS MUE Quarterly review, and CMS Therapy Code list
- Worked on other processes like OCE file review, LCD review, CMS Transmittals review etc
- Worked with the Product Team as Subject Matter Expert (SME) to enable automation of the DME process
- Performed detailed data analysis in reviewing Claim scenarios, BRAT reports, and Financial reports for client query resolution and research purpose
Leadership
- Independently managed the assigned Content related projects to the team members and assisted Supervisors/Managers in handling operational activities
- Supported quarterly and annual updates in collaboration with the US Team
- Worked diligently to meet and exceed productivity and quality benchmarks for self and the team
- Provided peer review and quality assurance support to the team
- Participated in relevant training and development activities (Completed 5 Professional Developmental series)
Clinical Associate
IKS Health
12.2017 - 12.2018
- Managing US physician's documentation on an electronic platform
- Listening to the physician patient interaction and summarizing the same in the electronic health record
- The summarized notes reflected in-depth patient's complaints (history of present illness, review of systems, physical examination, etc) and physician's plan around the same
- The chart note was generated and used by the physician as a reference document
Medical Writer
Vitality Solution's
05.2016 - 05.2017
Ayurvedic Practitioner
Anjali Mukerjee Health Total Pvt Ltd
11.2014 - 03.2016
Medical Officer
RBSK Under NRHM Program Of State Of Maharashtra
08.2013 - 06.2014
Education
BAMS -
Dr. D. Y. Patil College of Ayurveda, Nerul
Navi Mumbai12.2010
Post Graduate Proficiency in Panchakarma - Ayurvedic Medicine
RIHSM, Pune
Pune06.2013
HSC -
Bharati Vidyapeeth Junior College, CBD
Navi Mumbai02.2006
SSC -
St. Joseph High School, Kalamboli
Navi Mumbai03.2004
Skills
- US Healthcare
- People Management
- Research Analyst
- User Acceptance Testing
- Data Analysis
- Claims Analysis and Management
- Quality Analysis
- Agile and Scrums
- SAFe 5 & 6 Certification
- Process Ownerships
- Process Documentation and Review
- CPT and HCPCS
- ICD-10 CM
- Medical coding
- JIRA
- Basics of Confluence
Achievements and Recognitions
- Received Quarterly Performance award in Q3 2022 for Detailed Process documentations, maintaining high quality in majority of the processes, preventing errors in adjudication by timely identification
- Received multiple Monthly Reward and Recognitions (RnRs) for exceptional performance on various processes and handling client queries tactfully
Languages
English
Marathi
Hindi
Personal Information
Marital Status: Married
Date of Birth: 23/06/1988
Timeline
Team Lead Clinical Content Operations
Cotiviti Pvt Ltd
01.2019 - 11.2023
Clinical Associate
IKS Health
12.2017 - 12.2018
Medical Writer
Vitality Solution's
05.2016 - 05.2017
Ayurvedic Practitioner
Anjali Mukerjee Health Total Pvt Ltd
11.2014 - 03.2016
Medical Officer
RBSK Under NRHM Program Of State Of Maharashtra
08.2013 - 06.2014
BAMS -
Dr. D. Y. Patil College of Ayurveda, Nerul
Post Graduate Proficiency in Panchakarma - Ayurvedic Medicine
RIHSM, Pune
HSC -
Bharati Vidyapeeth Junior College, CBD
SSC -
St. Joseph High School, Kalamboli
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