MBBS, Duty doctor, RMO

S R Sowjanya B

Email: ****************@*****.***

Ph no- +91-916*******

Objective

To pursue a healthcare, medical oriented career in an organization where my professional skills and competencies share a symbiotic relation with the organization’s business objectives and corporate vision. I wish to professionally associate myself with a people centric organization of high repute, which has strong societal commitment, high values and a thoroughly professional environment that demands as well provides the best.

Education

SSC 10th BOARD OF SECONDAY EDUCATION ANDHRA PRADESH 2002 with an aggregate of 66.67

10+2 Intermediate BOARD OF SECONDAY EDUCATION ANDHRA PRADESH 2004 with an aggregate of 74.5

Bachelor of Medicine and Bachelor of Surgery (MBBS) – Chongqing Medical College, China [July 2011], GPA – 3.5/4.0

Assets

Attitude to learn new techniques and quick adaptation to the new environment, multidimensional view of a problem, Excellent communication skills, willingness to learn, amicable team member.

Troubleshooting to resolve the technological issues.

Self-motivated and self-confident-sound leadership and decision-making ability.

Experience in preparing claim appeal letters and proper medical documentation.

Computer Skills

Proficient use of Microsoft Word, Outlook, Excel and Access

Adobe Acrobat Standard

Keyboard typing 50 words per minute.

EMR software EPIC, eClinical, Meditech, Cerner, Allscripts

Trainings

12 months internship program from Chongqing medical university, China. Cleared Medical Council of India examination in 2015 and certified in Andhra Pradesh Medical Council.

Trained in ACF (Admit criteria form) Team, IQL(InterQual)Team and denial management- Appeals Team from August 2016 to October 2017.

Certified in Basic Life support from Medvarisity in November 2019.

Training in 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO), CPT (Current procedural Terminology), PCS (Procedure coding system), CPC for OP coding, Day Surgery, CCS for IP coding from January 2020 to present.

Training in CCEBDM (The Certificate Course in Evidence Based Diabetes Management is based on the principles of Evidence Based Medicine) by Public Health Foundation of India (PHFI), New Delhi and Dr. Mohan’s Diabetes Education Academy (DMDEA), Chennai from November 2019 to present.

Roles and Responsibilities:

Worked as duty doctor in cardiac department for 2013 December - 2015 January. Taking medical histories, performed physical examinations under the supervision of the physician, discussed and worked on investigations, management and treatment of patients. counseled and have done surveys of patients on different aspects of diseases like hypertension, diabetes mellitus and obesity while working with Physician.

Worked in Kolors Pvt Ltd.as a consultant Doctor in Cosmo dermatology Department from July 2015 -November 2015. Trained in various hair and skin Treatments which include Stem Cell Therapy, Platelet Rich Plasma (PRP), Derma Roller, etc.

Worked in Ramesh Hospitals from December 2015- June 2016. Taking medical histories, performed physical examinations under the supervision of the physician, discussed and worked on investigations, management and treatment of patients. counseled and have done surveys of patients on different aspects of diseases like hypertension, diabetes mellitus and obesity while working with Physician.

Worked in Primera Medical Technologies (USA) as a physician (process executive) in Appeals team-Denial Management from August 2016 – 2017 September. Primary role in assisting CDS and medical staff members with improving quality of medical documentation. Utilize both clinical and coding knowledge to obtain appropriate documentation and coding. Denial management; handling critical claims and performing extensive follow up for medical insurance rejections by 3rd party.

Worked in Ramesh hospitals as a Duty Medical Officer from November 2019 – January 2020.

Rejoined in Primera Medical Technologies (USA) as a physician (process executive) in Appeals team-Denial Management from April 2020 – Present. Primary role in Outpatient/Inpatient Appeals. Utilize both clinical and coding knowledge to obtain appropriate documentation and coding. Denial management; handling critical claims and performing extensive follow up for medical insurance rejections by 3rd party.

Clinical

Duties included Scheduling patient visits, Insurance processing and assisted them with forms if needed.

Taken medical histories, performed physical examinations under the supervision of the physician, discussed and worked on investigations, management and treatment of patients.

worked on Medical billing, coding, and insurance claims

counseled and have done surveys of patients on different aspects of diseases like hypertension, diabetes mellitus and obesity while working with Physician.

Skills:

-Assisting the senior doctor in checking the patients.

-Diagnosing the disease as per the symptoms.

-Observing and performing the examination of samples for disease diagnose.

-Learning the diagnostic methods and equipment’s.

-Periodically meeting the patients and observing their improvements and making reports.

-In case of emergency giving the basic treatment to the patients.

-Helping other medical staff in performing their duties.

Clinical Documentation/Appeals Specialist (Outpatient/Inpatient Appeals) at Primera Medical Technologies (2016-Present) with a position-Medical Reviewer

Analyzes Documentation present in the medical record for inpatient visit to ensure accuracy of diagnosis and procedure codes assigned by the coders.

Finalizes the coding and abstracting of the medical record upon ensuring the assignment international classification of diseases

Primary role in assisting CDS and medical staff members with improving quality of medical documentation

Utilize both clinical and coding knowledge to obtain appropriate documentation and coding.

Managing medical insurance claims for around 20 US based hospitals by acting as case documentation specialist and coordinating with US physicians for accurate diagnosis and admit criteria form documentation.

Denial management; handling critical claims and performing extensive follow up for medical insurance rejections by 3rd party.

Documentation and auditing Appeals to insurance companies for certain claims requiring in depth investigation and analysis for reasons for denial by insurance company and providing supporting documents and evidence for acceptance.

STRENGTHS

-Excellent theoretical knowledge.

-Excellent communication skills.

-Good knowledge of clinical practices and protocols.

-Ability to handle different types of patients.

-Flexible and adaptable.

-Extremely motivated towards career.

-Quick Learner.

Personal skills

-Polite.

-Confident.

-Have patience.

-Helping nature.

-Disciplined.

-Ability to handle the stressed situation.

Declaration: I hereby declare that the above furnished information is true to the best of knowledge.

Dr Sowjanya

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