Lakshmi Prasanna Putluru
Hyderabad
Summary
Accomplished medical coder with extensive experience in claim assessment and regulatory compliance. Strong attention to detail and communication skills enable effective collaboration with healthcare providers to identify fraudulent behaviors and ensure billing accuracy.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Senior Clinical investigator(surgery coder)
Optum Global Solutions
Hyderabad
02.2025 - Current
- Reviewed prepay claims and medical records to ensure payment accuracy and compliance.
- Analyzed policies, CPT guidelines, and contracts relevant to clinical review.
- Reviewed applicable policies, CPT guidelines, and contracts to ensure compliance in clinical review.
- Identified fraudulent behaviors including upcoding, unbundling of medical services, duplicate claims, and inflated charges to protect revenue integrity.
- Collected and documented evidence to support adherence to legal and regulatory standards in clinical review.
- Utilized expertise in medical coding standards and reimbursement policies to verify billing correctness and facilitate compliance.
- Monitored claim inventory to maintain compliance with performance guarantees.
- Utilized tools such as PICTS, Encoderpro, Exodes, and ISET to enhance claim processing efficiency.
Senior Process Executive
Cognizant
Hyderabad
06.2023 - 04.2024
- Interacting with US health care physicians on day-to-day for providing the documentation to the physicians.
- Coordinated with physicians daily to develop and refine patient chart note structure.
- There will be a day to day interaction with physicians to coordinate and work on the patient chart note structure.
- There will be a day to day interaction with physicians to coordinate and work on the patient chart note structure.
Clinical Investigator(Surgery coder)
Optum Global Solutions
Hyderabad
06.2020 - 02.2022
- Prevented payment of potentially fraudulent and abusive claims by applying medical expertise, CPT/diagnosis codes, CMC guidelines, and client-specific guidelines.
- Reviewed and determined approval or denial of claims while identifying provider aberrant behavior patterns.
- Identified discrepancies between medical records and billed services in complex, high-value claims by detecting up-coding, unbundling, duplication, and misrepresentation of services.
Physiotherapist
Germanten
Hyderabad
07.2019 - 01.2020
- Assessed patient conditions and created tailored treatment plans to address individual needs.
- Administered therapeutic exercises to improve mobility and increase strength in patients.
- Evaluated patient progress at regular intervals, adjusting treatment plans to optimize recovery outcomes.
Education
BPT - Paramedical
NTR UNIVERSITY
Hyderabad05-2019
Intermediate Certificate - BiPC
Sri Chaitanya Junior Kalasala
Hyderabad04-2014
SSC -
Naagarjuna High School
Hyderabad04-2012
Skills
- Surgical coding
- Medical coding
- Clinical review
- Claim assessment
- Regulatory compliance
- Patient documentation
Certification
- AAPC Certified Professional Coder (CPC)
- Advanced PG Diploma in Clinical Research, Pharmacovigilance and Clinical Data Management from Clinosol Research Pvt Ltd
Declaration
- I hereby declare that above specified information is true to best of knowledge and belief.
Place: Hyderabad Lakshmi Prasanna
Timeline
Senior Clinical investigator(surgery coder)
Optum Global Solutions
02.2025 - Current
Senior Process Executive
Cognizant
06.2023 - 04.2024
Clinical Investigator(Surgery coder)
Optum Global Solutions
06.2020 - 02.2022
Physiotherapist
Germanten
07.2019 - 01.2020
BPT - Paramedical
NTR UNIVERSITY
Intermediate Certificate - BiPC
Sri Chaitanya Junior Kalasala
SSC -
Naagarjuna High School