Varghese A.
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Varghese A. is a detail-oriented Healthcare Operations Specialist with over three years of experience focusing on US insurance claims processing and medical scribing. At Cognizant Technology Solutions Private Ltd, he serves as a Process Specialist, acting as the "Human-in-the-Loop" element to ensure compliance with US healthcare regulations and HIPAA mandates. He expertly manages workflows, validates high-volume healthcare insurance claims, and verifies patient eligibility, enrolling in processes that reduce front-end rejections. His comprehensive knowledge includes reviewing claims for proper medical coding alignment, utilizing electronic health records (EHR) and AI tools to transform clinical data into structured claim elements. Previously, Varghese was a Senior Process Executive, managing medical documentation accuracy, compliance with regulations, and utilizing EHR systems effectively. His foundational education in Medical Scribing from Transorze Solutions and a Bachelor of Business Administration from Mahatma Gandhi University supports his proficiency in handling complex healthcare documentation and regulatory requirements.
Experience
PROCESS SPECIALIST
COGNIZANT TECHNOLOGY SOLUTIONS PRIVATE LTD · 2025 — PresentPerform the critical 'Human-in-the-Loop' function by auditing AI-adjudicated claims that do not meet confidence thresholds, ensuring compliance with US healthcare regulations and HIPAA requirements. Process and validate a high volume of US healthcare insurance claims following payer-specific guidelines along with state and federal laws. Verify patient eligibility, enrollment, and benefits to enhance coordination of benefits and minimize front-end rejections. Review claims to ensure correct medical coding alignment with clinical documentation across ICD-10-CM, CPT, and HCPCS codes. Analyze clearinghouse rejections and data transmission errors to address data discrepancies. Conduct internal audits on AI-processed claims to uphold accuracy and limit financial risks while consistently achieving production targets and quality assurance metrics. Utilize AI machine learning tools to transform unstructured clinical data into formatted claims, thereby improving adjudication efficiency.SENIOR PROCESS EXECUTIVE
COGNIZANT TECHNOLOGY SOLUTIONS PRIVATE LTD · 2023 — 2025Supervise the accurate and timely documentation of patient interactions, encompassing medical histories, symptoms, treatments, and test results. Assess and refine medical records for completeness and compliance with regulations. Ensure adherence to healthcare regulations and privacy laws, including HIPAA, regarding medical documentation and data protection. Effectively employ electronic health records (EHR) systems and medical software for documenting patient encounters and retrieving necessary medical information.QUALITY DOCUMENTATION SPECIALIST
NUANCE INDIA PVT. LTD · 2022 — 2023Conduct reviews of medical documentation, including patient charts and reports, to guarantee accuracy, completeness, and compliance with established standards. Perform regular audits to identify opportunities for improvement in documentation practices and ensure compliance with regulatory requirements, such as HIPAA. Stay updated on regulatory changes to refine documentation practices accordingly. Develop and enforce standardized templates and guidelines for documentation across various specialties, monitoring adherence and facilitating training when deviations occur.
Skills & Expertise
Education
- Bachelor of Business AdministrationMahatma Gandhi University · 2016 — 2020
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