Dr Arun Gandhi
Banglore,karnataka
Summary
Senior Medical Coder/Clinical Reviewer with a 96% coding accuracy track record at VeeHealthtek. Highly skilled in clinical data management, with a strong focus on prospective, retrospective, and concurrent reviews. Demonstrated expertise in patient data analysis and compliance audits, consistently delivering exceptional coding results of the highest quality.
Overview
3
3
years of professional experience
1
1
Certification
Work History
Clinical Reviewer
VeeHealthtek
03.2023 - Current
- Achieved 96% coding accuracy as a 'Certified Professional Coder (CPC)'
- Conducted coding audits to ensure compliance with regulations
- Reviewing patient data before an encounter to identify potential HCC conditions and ensure accurate coding ultimately improves risk adjustment and reimbursement for healthcare providers Evaluation of members' clinical status, benefit plan, and appropriateness for internal and external programs and sites of service in order to facilitate determination of cost-effective, medically necessary plan of care.
Reviewed and analyzed medical care reports to assess medical necessity and appropriateness of treatments.
Analyzing patients' adverse event cases to ensure compliance with regulatory requirements.
Reviewed and provided medical expertise for regulatory submissions, ensuring high-quality documentation.
Conducted detailed analyses of medical data to identify causes of Patient health issues in future.
Review and analysis of medical reports & labs & imaging documentation for the patient's upcoming health risk to be taking care.
Analyzing patient data of retrospective & concurrent records, resulting in suspecting of certain disease conditions based on clinical indicators to the provider for better patient care as a prospective review.
Frequent reviewing of all patients' clinical indicators for anal - Projects Involved:
- 1. P3 prospective
- 2. Summa Care MA
- 3. Summa Care ACA
- 4. Harmonycares RADV (Audit Process)
- Tools Experienced:
- Epic
- Cerner
- Ciox
Executive Medical Coder
Corrohealth
05.2022 - 02.2023
- Executive Medical Coder
- Projects Involved:
- 1. HUMANAMRA
- 2. OPTUM MRA
- 3. COTIVITI ANTHEM
- 4. CIGNA
- 5. OPTUM LOAN MRM
- Tools Experienced:
- 1. Ciox
- 2. Cerner
Education
DOCTOR OF PHARMACY - PHARM.D
DR.MGR University
01.2022
Skills
- Medical chart review
- Clinical data management
- Coding accuracy
- Epic charting
- HCC coding
- ICD-10 coding
- Healthcare reimbursement
- Patient data analysis
- Cerner documentation
- Risk adjustment
Certification
Certified Professional Coder
Additional Information
Effect of 5S PDCA technique on the improvement of pharmacy inventory management system on a major trauma care centre
Disclaimer
Languages
English
Tamil
Disclaimer
I hereby declare that the particulars mentioned above are accurate to the best of my knowledge, and I accept responsibility for their accuracy.
G Arun
Timeline
Clinical Reviewer
VeeHealthtek
03.2023 - Current
Executive Medical Coder
Corrohealth
05.2022 - 02.2023
DOCTOR OF PHARMACY - PHARM.D
DR.MGR University
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