Pankaja Gautam
Gandhinagar
Summary
- Certified Medical Coder (CPC) with experience in E&M with multi speciality in accurate risk adjustment and compliance with CMS and industry guidelines.
- Proven expertise across inpatient, outpatient, and preventive care coding, with exposure to multiple projects, EMR systems, and coding tools.
- Skilled in auditing, guideline development, and team collaboration, contributing to improved coding quality, consistency, and operational efficiency.
Overview
5
5
years of professional experience
2
2
years of post-secondary education
Work History
Medical Coder
Ingenious BPO
Noida
01.2026 - Current
- Performed E&M (Evaluation and Management) coding across multiple specialties for both outpatient and inpatient encounters, ensuring accurate documentation and code assignment
- Applied Medicare and commercial coding guidelines to maintain compliance and minimize claim denials
- Assigned ICD-10-CM diagnosis codes, along with CPT and HCPCS codes for minor and major procedures, ensuring complete and accurate coding
Medical Coding Analyst
Optum-UHG
Noida
01.2024 - 01.2026
- Specialized in E&M coding for Behavioral Health, accurately assigning ICD-10-CM and CPT codes for mental health and psychotherapy records
- Worked on ABA (Applied Behavior Analysis) therapy records for autism patients, ensuring accurate coding and compliance with treatment-specific documentation requirements
- Conducted coding audits and collaborated with onshore teams to maintain quality standards and improve overall coding accuracy
- Provided team mentoring and training support, while contributing to weekly guideline updates and preparation to ensure adherence to evolving coding standards
Medical Coder
Advantmed LLP
Gandhinagar
03.2022 - 01.2024
- Specialized in HCC coding for both inpatient and outpatient records, ensuring accurate risk adjustment, compliance, and adherence to industry standards
- Worked on projects including Prominence, MMR, Sumacare, MMMIP, and Boston DXCG, while supporting record retrieval processes to ensure workflow continuity
- Delivered accurate preventive medicine E&M coding in the Provider First department for both commercial and Medicare plans, utilizing CMS and NCQA guidelines and contributing to the development of standardized guidelines and SOPs to enhance coding consistency and quality
Research Associate
Lambda Reasearch & Therapeutics
Ahemdabad
12.2020 - 01.2022
- Conducted effectiveness studies on dermatological and disinfectant products, analyzing microbial counts and retention on human subjects
- Performed data analysis and report preparation, presenting findings to stakeholders and supporting research outcomes
Education
Msc - Microbiology
Nirma University
Ahemdabad, India 06.2017 - 06.2019
Skills
- Coding Tools: Epic, EncoderPro, Codify, RAPID, RFI 20
- EMR/EHR Systems: eClinicalWorks (eCW), Practice Fusion
- Payer Platforms: Aetna
- Other Tools: Citrix
Languages
Gujarati
First Language
Hindi
Proficient
C2
English
Proficient
C2
Timeline
Medical Coder
Ingenious BPO
01.2026 - Current
Medical Coding Analyst
Optum-UHG
01.2024 - 01.2026
Medical Coder
Advantmed LLP
03.2022 - 01.2024
Research Associate
Lambda Reasearch & Therapeutics
12.2020 - 01.2022
Msc - Microbiology
Nirma University
06.2017 - 06.2019