Avinash Tandale

Prior authorizaion specialist

• Assisted with day-to-day operations, working efficiently and productively with all team members.
• Managed time efficiently in order to complete all tasks within deadlines.

• Improved medical coding accuracy by conducting thorough reviews and implementing corrective actions.
• Reduced claim denials by identifying and addressing common errors in the coding process.
• Mentored junior team members, helping them to enhance their skills and knowledge in medical coding best practices.

Exposure of multiple project Anesthesia, Pain Management

Knowledge of

LCD Policy.

LCD Diagnosis.

NCCI Edits.

Assigning correct anesthesia CPT code (00100 - 01999)

Reviewing anesthesia records for documentation accuracy

Knowledge of Anesthesia Concept

1) Anesthesia Modifiers (Physical status, Qualifying Circumstances)

2) Base Unit, Time Unit

3) Bundled and Unbundled services

4) Familiar with EHRs and coding software:

Encoder Pro

Ebridge

Kareo(Tebra)

Review ED Professional Encounter notes and assign correct E/M levels.

Ensure Compliance with coding guidelines, modifiers and payor specific rules.

Escalate unclear chart to physician

Knowledge of ED concept-

1) E/M Level Selection( cpt code 99281-99285)

2)Minor Procedures

(Laceration repair, Incision and Drainage, Fracture Care, Splinting Casting)

3) ED Modifier (25, 59)

4) Documentation Format SOAP (Subjective, Objective, Assessment, Plan)

5)Critical Care guidelines

HCC (Hierarchial Condition Category) Coding

Learn about HCC coding concepts.

1) Risk Adjustment Factor (RAF).

2) Capture of Chronic Conditions.(DM, CKD, CHF, MO, VD, Cancer)

3) MEAT Concept (Monitor, Evaluate,Assess, Treat)

4)One Year Rule

5)HCC Model (CMS-HCC V24 and V28 for Medicare Advantage, HHS-HCC for ACA Marketplace)

Coding Challenges-

a)Upcoding

b)Under coding

c)Documentation Gap

• Analyze medical documentation for office visit, telehealth, consultation, and follow-ups.
• Identify and Extract relevant component: History, Examination and Medical Decision Making
• Appliied Different coding guideline and concept:

Time based coding, Mdm based coding, ENM Modifier(24,25, 57)

• Familiar with EHRs and Coding software

Athena

Epic

• Educated patients on proper medication administration techniques, ensuring safe and effective use.
• Reduced medication errors by implementing quality control measures and maintaining accurate prescription records.
• Improved patient outcomes by accurately dispensing medications and providing thorough medication counseling.

Review patient records, clinical document, and medical report.

Assign appropriate ICD-10-CM, CPT, and HCPCS codes for diagnoses, procedure and services.