Aishwarya Raja

About Aishwarya Raja

Researcher Recruiter ReformerHCC & RxHCC Coding Specialist | Risk Adjustment Professional | Strategic Healthcare PartnerBridging scientific precision with healthcare strategy, my work sits at the intersection of clinical documentation, regulatory compliance, and value-based care.As a CPC-A Certified Risk Adjustment Professional and Client Partner at Access Healthcare, I drive CMS-aligned risk adjustment initiatives with a strong focus on RAF optimization and ICD-10-CM accuracy. My experience spans multi-payer engagements including Centene, Oscar Health, Aetna, Providence Health Plans, Security Health Plan, Kelsey-Seybold Clinic, and Horizon Blue Cross Blue Shield—ensuring accuracy, documentation integrity, and precise risk score outcomes while consistently meeting quality and productivity benchmarks.Earlier at Optum, I contributed to key programs such as Aetna Wellcare (MA & ACA) and WellMed, strengthening expertise in CMS documentation standards, audit readiness, and compliance-driven coding practices. Recognition as a Best Performer reflects a sustained commitment to productivity and quality excellence.The professional journey began in U.S. pharmaceutical staffing, managing end-to-end recruitment for clinical and scientific roles. That foundation sharpened stakeholder coordination, analytical thinking, and structured process execution skills that now enhance performance within complex healthcare ecosystems.An M.Tech graduate in Genetic Engineering, with authorship in Cancer Genes Volume 2: Chromosome 13 (Bentham Science, 2023) and contributions to peer-reviewed research, scientific rigor remains a core strength behind every professional decision.Additionally, I hold the Google Project Management Certificate, reinforcing my structured planning, execution management, and cross-functional coordination capabilities.Beyond my corporate journey, I founded a student-driven NGO and held multiple academic leadership roles, demonstrating initiative, accountability, and team leadership from an early stage.Driven by accuracy, integrity, and impact and also committed to strengthening healthcare data quality and advancing value-based care models across the U.S. healthcare landscape.

Experience

1. Client Partner

   Access Healthcare

   Oct 2025 — Present · Ambattur, IN

   Working on risk adjustment HCC coding projects for multiple U.S. health plans including Centene Corporation, Oscar Health, Aetna, Providence Health Plans, Security Health Plan, Kelsey-Seybold Clinic, and Horizon Blue Cross Blue Shield. Conducted detailed medical record reviews and applied ICD-10-CM coding guidelines to identify and capture chronic conditions for accurate risk adjustment and RAF score calculation. Ensured compliance with CMS and payer-specific coding standards, maintained high quality and productivity targets, and demonstrated strong analytical and documentation review skills in a fast-paced environment.

Education

• PRATHYUSHA ENGINEERING COLLEGE

  Bachelor of Technology (B.Tech.), Biotechnology

  2015 — 2019

• The New John Dewey Matric Hr.Sec.School,Villupuram

  Class of 8th-10th, General

  2009 — 2012

• SRM IST Chennai

  Master of Technology - MTech, Genetic Engineering

  2019 — 2021

• E.S.Matric.Hr.Sec.School,Villupuram

  Class of 5th -7th, General

  2006 — 2008

• Achariya World class Institutions

  Higher Secondary Education , Biology with Maths

• The Claribel Matric School,Villupuram

  Class of KG- 4th, General

  2000 — 2005