LANKADASARI DIVYASHREE
HYDERABAD
Summary
Accomplished Assoc Clinical Admin Coordinator and Pharmacy Benefit Analyst with a proven track record at UHG and Optum Global Advantage. Expert in Clinical Administration and Advanced Excel, adept at analyzing healthcare data and optimizing claims processes. Demonstrates exceptional analytical skills and a commitment to enhancing revenue cycle management through effective data governance and compliance.
Overview
3
3
years of professional experience
Work History
Assoc Clinical Admin Coordinator
Optum Global Solutions(UHG)
HYDERABAD
01.2023 - 12.2024
- Triaging the inventory items when they are referred to the (Claim Consult) department by other areas of the company
- Reviewing of claims based on service that receive system generated “Edits”
- Triaging these items is to determine whether the rendered service requires a review by the MCR Claim consult, clinical review staff, or not.
- Handling High Dollar Claims
- Adjusting all types of Claims and Cross auditing the claims
- Checked documentation for appropriate coding, catching errors and making revisions
- Gathering all related clinical information, related claims, and any other outstanding items information in order to create a case for clinical review staff to review the appropriateness of the service rendered
- Analyzing claims denials and determine the appropriate corrective actions
- Service in question can be handled by the Intake Specialist based on specific information documented in an Internal Unit Guideline, the Intake Specialist’s duty is to complete the review, document the outcome of the review and the return the item for processing
Pharmacy Benefit Analyst
Optum Global Solutions(UHG)
HYDERABAD
07.2022 - 01.2023
- Structured and Updating the existing benefits plans of the clients
- Determining the best pharma benefits plans for the clients by conducting research
- Ensuring timely communication with the client to make changes in the plan
- Responding to all claims processing requests from the client
- Developing and running macros in Rx CLAIM to implement all plan requests
- Responsible To work on all types of cases such Fully Insured (FI), Administrative Service Only (ASO) responsible to work on all type of Maintenance/ Renewals and new business group
Education
B.pharmacy -
ANURAG GROUP OF INSTITUTIONS
HYD01.2019
Intermediate - Bi.P.C
SRI CHAITNAYA JR COLLEGE
HYD01.2015
10th -
BRILLIANT GRAMMAR HIGH SCHOOL
HYD01.2013
Skills
- Windows 8/10
- Proficient in MS Word, Excel, and PowerPoint
- Clinical Administration
- Revenue Cycle Management (RCM)
- Analysis and Reporting of Healthcare Data
- Claims Review and Processing
- Data Governance and Compliance
- Insurance Claims Forms Review
- Advanced Excel (Data Analysis, Complex Formulas)
Accomplishments
- Achieved Bravo Award for Performing with 100% accuracy in team level
- Served as a mentor and primary support for a team of 20 newly joined coordinators at a Hyderabad site, facilitating their operational workflow.
- Coordinated team-wide activities, serving as the primary point of contact between team members and management.
- Certified in Advanced Excel, skilled in data analysis, complex formula management and pivot table
Disclaimer
I hereby declare that all the details furnished above are true to the best of my knowledge.
Timeline
Assoc Clinical Admin Coordinator
Optum Global Solutions(UHG)
01.2023 - 12.2024
Pharmacy Benefit Analyst
Optum Global Solutions(UHG)
07.2022 - 01.2023
B.pharmacy -
ANURAG GROUP OF INSTITUTIONS
Intermediate - Bi.P.C
SRI CHAITNAYA JR COLLEGE
10th -
BRILLIANT GRAMMAR HIGH SCHOOL
Similar Profiles
Anshul MalikAnshul Malik
Manager Software Engineering at Optum Global Solutions (UHG)Manager Software Engineering at Optum Global Solutions (UHG)
Suresh MaheshwaramSuresh Maheshwaram
Senior Analyst at Optum Global Solutions (UHG)Senior Analyst at Optum Global Solutions (UHG)
John Paul Sta MariaJohn Paul Sta Maria
IT Service Desk Analyst at Optum Global Solutions, UHGIT Service Desk Analyst at Optum Global Solutions, UHG