Sangeetha R

Accomplished healthcare coding professional with 20 years of multi-specialty experience, including 1.5 years in HCC, 12+ years in Emergency/Outpatient, E/M, and Same Day Surgery, and 5.5 years in Inpatient coding. Expertise spans medical claims auditing, department leadership, coordination and problem-solving with hospital services and external agencies.

Senior Manager - OPTUM - Vijayawada Branch

(2025-02)

• Lead a team of 350+ coders, 15 Team Leads, 3 Group Leads, and 1 Manager in HCC coding.
• Oversee People & Process management, SLA production, and quality standards.
• Support multiple Risk Adjustment projects for key clients.
• Achieve above 95% SLA quality and realistic forecast projections, ensuring target attainment.
• Manage Salesforce App for project tracking and reporting.
• Conduct daily/weekly reviews, RCA analysis, and coaching to address performance gaps.
• Monitor team attendance, training compliance (AAPC), and client communications.
• Drive KPI dashboards, scorecard adherence, and revenue monitoring.
• Manage client escalations, CAPA, leave approvals, budget allocation, and operational supervision.

Operations Manager - MMX - Chennai

(2024-03 - 2024-10)

• Managed a team of 80+ coders in Inpatient, Outpatient Surgery, Ancillary, and Denial Management.
• Collaborated with Training and Quality teams to improve process efficiency and achieve targets.

Assistant Manager - Omega Healthcare Pvt. Ltd - Chennai

(2021-06 - 2024-03)

• Supervised 40+ IP coders, 3 TLs, and 10 auditors, ensuring SLA compliance and quality standards.
• Conducted audits, feedback sessions, and daily education updates for coding teams.
• Coordinated client calls, town halls, and weekly deck preparation.
• Monitored weekly/monthly revenue, conducted one-on-one performance analyses, and enforced RCA on QA errors.
• Managed fake coder removal, team training adherence, and client-specific requirements.
• Led Quality Improvement Programs, daily coding quizzes, and coding clinics.
• Assisted in senior management duties during ML/resignations to ensure seamless operations.

Senior Clinical Coding Executive - SEHA, Ambulatory Health Services - Abu Dhabi, UAE

(2013-11 - 2021-04)

• Delivered E/M and coding training to coders and physicians.
• Provided Clinical Documentation Improvement training to physicians.
• Interpreted medical terminology and pharmacology for accurate coding.
• Performed statistical analyses and claims review, ensuring compliance and accurate patient billing.
• Utilized CPT and ICD-10 CM for claims processing; managed 3M and Cerner software systems.
• Led Tasneef external audit achieving "A" grade with >96% score at Hili Clinic.
• Managed Corona Isolation Project for Home Care Quarantine patients (Jan–Mar 2021).
• Acted as liaison to CDI specialists, physicians, and auditors; facilitated query resolution.
• Maintained strict confidentiality and compliance with hospital/state guidelines.

Medical Claims Auditor & Inpatient DRG Coder - Alnoor Hospital - Abu Dhabi, UAE

(2011-12 - 2013-09)

• Performed inpatient claim audits, reported findings, and trained new claims examiners.

Medical Claims Auditor & Inpatient DRG Coder - Sheikh Khalifa Medical City - Abu Dhabi, UAE

(2010-06 - 2011-09)

• Inpatient DRG coder, processed multi-specialty files with 99% accuracy.

Team Coordinator – Coding - Lister Technologies Pvt. Ltd. - Chennai

(2009-04 - 2010-06)

Medical Coder – Multi-specialty - Techno Soft Global Pvt. Ltd. - Chennai

(2008-09 - 2009-02)

Medical Coder - Omega Healthcare Pvt. Ltd. - Chennai

(2006-10 - 2008-03)

B.Sc. - Psychology - Madras University (2010)

Bachelor - Occupational Therapy - Santosh College of Occupational Therapy, M.G.R. Medical University (2006)