NAVINKUMAR Sakthi
Hyderabad
Summary
Expert in meticulous clinical case reviews, medical record audits, and compliance assessments. Proficient in Epic and Meditech EHR systems, patient assessment, emergency care, regulatory guideline application, and interdisciplinary collaboration. Seeking to leverage strong clinical and regulatory expertise in a challenging role.
Talented Operations Coordinator successful at supervising and directing daily efforts of project teams and developing effective work procedures and processes. Results-oriented and organized with extensive experience working in fast-paced environments to consistently meet operational targets.
Highly accomplished and motivated Medical Review Specialist and MBBS Doctor with 2.5 years of experience in a
fast-paced healthcare company, complemented by 10 months of clinical experience as a Duty Doctor.
Overview
3
3
years of professional experience
7
7
years of post-secondary education
Work History
Operations Coordinator - Utilization Management
Primera Medical Technologies
Hyderabad
10.2023 - Current
- Conducted high-volume clinical case reviews (utilization management, retrospective claims) to determine medical necessity, guideline adherence, and appropriate billing.
- Performed comprehensive medical record audits across multiple specialties ensuring documentation accuracy and compliance readiness.
- Managed complex patient data using Epic and Meditech EHR systems while maintaining confidentiality and data integrity.
- Led internal quality assurance initiatives resulting in improved review accuracy and reduced audit discrepancies.
- Interpreted and applied HIPAA, state/federal regulations, and payer-specific policies in all review decisions.
- Lead a team of SME’s on automation project
- Supported project management initiatives through effective scheduling and resource allocation.
Duty Doctor
Prolife multi-specialty hospital
Bangalore
10.2022 - 07.2023
- Provided comprehensive patient assessment, stabilization, and monitoring for inpatients and emergency cases.
- Managed routine and complex emergency scenarios, initiating critical care protocols with timely decision-making.
- Performed accurate diagnosis and treatment planning across diverse medical conditions.
- Ensured real-time, precise documentation of patient care using hospital EHR systems.
- Collaborated effectively with nurses, specialists, and allied staff to optimize patient outcomes.
Education
Bachelor of Medicine, Bachelor of Surgery - Clinical Medicine
Guangxi Medical University
Nanning, China 11.2013 - 12.2020
Skills
- Utilization management
- Medical record audits
- HIPAA compliance
- Project management
- Quality assurance
- SQL (intermediate)
- Medical documentation
- Effective communication
- Collaborative teamwork
- Critical thinking
- Administrative management
- Operations management
Personal Information
Title: Medical Review Specialist | MBBS Doctor
Languages
Tamil
First Language
English
Advanced
C1
Telugu
Upper Intermediate
B2
Chinese (Mandarin)
Upper Intermediate
B2
Timeline
Operations Coordinator - Utilization Management
Primera Medical Technologies
10.2023 - Current
Duty Doctor
Prolife multi-specialty hospital
10.2022 - 07.2023
Bachelor of Medicine, Bachelor of Surgery - Clinical Medicine
Guangxi Medical University
11.2013 - 12.2020