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sujala kumari

@sujalakumari

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Quality Auditor focused on data-driven healthcare RCM analytics, improving claim quality and operational efficiency.

India

Message

What I'm looking for

I’m looking for a healthcare analytics role where I can drive claim-quality improvements through SQL/Python analysis, Power BI dashboards, and RCM denial/root-cause insights—partnering with cross-functional teams and continuously optimizing processes.

I’m a Quality Auditor specializing in US Healthcare Medical Billing and Revenue Cycle Management (RCM), using data-driven analysis to enhance claim quality, operational efficiency, and business outcomes. In my current role, I conduct quality audits and analyze healthcare claims and revenue cycle operations, extracting, cleansing, validating, and interpreting data with SQL and Python to surface trends, errors, and process improvement opportunities.

I also build and maintain interactive dashboards and reporting in Power BI and Excel to monitor quality metrics and performance KPIs. Previously, as a Senior Analyst at Optum Global Solutions (UHG), I worked with UB-04 and CMS-1500 claims using SQL, Python, Excel, Power BI, and API/Webhook-based workflows to support denial analysis and process optimization, while providing training and mentorship to teams and contributing to Level-5 client projects.

Experience

Work history, roles, and key accomplishments

Current

Quality Auditor

Current

R1RCM

Feb 2023 - Present (3 years 5 months)

Conducts quality audits and data analysis of healthcare claims, billing, and revenue cycle operations to improve efficiency and quality metrics. Extracts, cleans, validates, and analyzes data using SQL/Python, builds Power BI/Excel dashboards and automated reports, and uses APIs/webhooks for reporting automation and root-cause analysis.

Healthcare Claims Analysis Data Extraction Data Cleaning SQL Python Power BI Excel Google Sheets APIs Webhooks Root Cause Analysis KPI Tracking Dashboard Development Data Quality

Senior Analyst

Optum Global Solutions (UHG)

Apr 2022 - Jan 2023 (9 months)

Performs healthcare data analytics focused on medical billing, including extraction, validation, and analysis of UB-04 and CMS-1500 claims data. Manages priority and HDV claims, conducts denial analysis with dashboards/reports, and contributes to Revenue Cycle Management (RCM) operations and client projects.

Healthcare Data Analytics Medical Billing Revenue Cycle Management Denial Analysis KPI Tracking SQL Python Power BI Google Sheets APIs Webhooks Priority Claims HDV Claims Medicare PPO

Senior Analyst

Getix Healthcare

Sep 2021 - Mar 2022 (6 months)

Audits and analyzes UB-04 and CMS-1500 claims to ensure compliance and accuracy for priority and HDV claim handling. Produces SQL/Python/Power BI reporting for denial trend analysis, supports API/webhook-based workflows, and mentors trainees while leading Level-5 client denial management and end-to-end RCM operations.

Claims Auditing Denial Analysis Priority Claims HDV Claims SQL Python Google Sheets Power BI APIs Webhooks Level 5 Client Projects

Education

Degrees, certifications, and relevant coursework

Scaler

Coursework, Data Science & Artificial Intelligence

2022 - 2025

Completed coursework in machine learning, generative AI, deep learning, and data analysis fundamentals including Python/SQL, EDA, and dashboarding tools.