Customer Service Medical Coding
Resume:
Srinath Doosa
Results-driven professional with experience in Claims Auditing and Medical Coding, skilled in claims investigation, verifying information, and resolving complex claims to enhance workflow efficiency. Proficient in using analytical tools to ensure compliance, improve processes, and deliver exceptional customer service. Experienced in maintaining detailed records for management review, correcting and resubmitting claims, preparing patient charts, and reviewing health records to identify accurate diagnosis codes for billing. Strong background in analyzing medical records, managing prior authorizations, and ensuring proper insurance payments. Skills
Work History
Medical Coder
R1 Rcm, Hyderabad Telangana, India February 2019 - February 2021 Shakopee, MN 55379
+1-952-***-**** **************@*****.***
Claims Investigation & Resolution Medical Coding
Billing & Invoicing Claims Management Systems
Medical Coding Proficiency Error Resolution & Appeals Data Management & Reporting Audit Support
Training & Mentoring EDI 837 Claims Management
Continuous Learning & Professional
Development
Confidentiality & Data Security
Team Collaboration
Accurately code medical diagnoses and procedures using ICD-10, CPT, and HCPCS codes. Follow healthcare regulations and payer guidelines for accurate coding and billing. Work with doctors and nurses to clarify documentation and ensure proper coding. Stay updated on coding guidelines, medical terminology, and industry changes. Ensure that patient records are complete and meet coding requirements. Prepare and submit accurate insurance claims for reimbursement. Address and correct errors or discrepancies in coding or claims. Engage in ongoing professional development and certification renewals. Regularly review coding work for accuracy and compliance. Monitor the status of submitted claims and follow up on any denials or rejections. Maintain accurate coding records for auditing and reporting purposes. Follow privacy regulations (like HIPAA) to ensure the security of patient data. Support internal or external audits by providing accurate coding documentation and information. Create and review reports on coding trends, denials, and reimbursement status. Collaborate with the billing team to ensure accurate and timely claims processing. Managed and processed EDI 837 claims to ensure accurate submission of healthcare services to insurance Claims Associate
Optum, UnitedHealth Group, Hyderabad, Telangana,
India
July 2016 - January 2019
payers.
Assist in training new coders or clinical staff on proper documentation and coding procedures. Issue final account bills to CCC based on direction from the Business Office Manager, ensuring accuracy and timely delivery.
Collaborate with internal departments to ensure accurate billing practices and adherence to company protocols.
Provide exceptional customer service by addressing any inquiries or issues related to billing promptly and professionally.
Notify CCC of payments received at the office by updating computer reports and maintaining up-to-date payment records.
Process and adjudicate healthcare claims with accuracy and within turnaround time (TAT) requirements. Review claim submissions for completeness, validity, and compliance with company policies and healthcare regulations.
Analyze medical documentation, coding, and policy coverage to determine claim eligibility. Investigate and resolve claim discrepancies, denials, and appeals in coordination with internal teams and external stakeholders.
Communicate claim determinations to providers, members, and clients while maintaining excellent customer service.
Work closely with healthcare providers and insurance representatives to verify patient eligibility and benefits.
Identify trends in claim rejections and report recurring issues to senior management for resolution. Ensure compliance with HIPAA, insurance policies, and data privacy standards. Utilize company software, claims management systems, and analytical tools to track and manage claims efficiently.
Participate in training sessions and continuous learning initiatives to stay updated on industry changes and claim processing guidelines.
Assist in process improvement initiatives to enhance workflow efficiency and reduce errors. Support audits and quality control checks to ensure compliance with internal and external regulatory standards.
Handle escalated claims and work with supervisors to resolve complex cases. Monitored and resolved claim rejections and denials related to EDI 837 submissions, ensuring timely resolution.
Maintain detailed records of claim transactions and prepare reports as needed for management.
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