Pratyusha V

• Performed real-time medical coding on live patient charts, ensuring accuracy under expert supervision.
• Assigning accurate ICD-10-CM, CPT, and HCPCS Level II codes.
• Reviewing clinical documentation for completeness and compliance.
• Applying coding guidelines and payer-specific rules.
• Enhanced coding accuracy and turnaround time through ongoing practice and refinement of skills
• Assisted in auditing processes, identifying and rectifying errors in coding practices to ensure compliance.
• Collaborated with healthcare providers to resolve coding discrepancies.

• Supervised cross-functional healthcare teams to enhance workflow efficiency
• Managed patient records, scheduling, and communication processes
• Worked extensively with Cerner EHR for clinical documentation and reporting
• Ensured compliance with regulatory standards and data accuracy
• Supported HIM workflows and diagnostic coordination

Systems: Cerner, 3M

• Managed medical records and patient workflows to support timely processing
• Coordinated with reviewers to address and close documentation gaps
• Reviewed medical opinions to ensure adherence to company standards
• Supported quality management and compliance initiatives
• Participated in complaint resolution and provider relations processes

Systems: ClearPath PriorAuth, Client Tools

• Processed pharmacy and billing claims while ensuring HIPAA compliance
• Assisted customers with claims, payments, and account updates
• Educated patients and providers on insurance products and services
• Managed high call volumes using multiple systems
• Generated reports on customer satisfaction and service quality

Systems: Citrix, Argus, GCP, CI-Screen, CMS

• Processed Individual Case Safety Reports (ICSRs) for clinical trials, ensuring timely and accurate reporting of safety data
• Assessed adverse events for seriousness and expectedness
• Maintained compliance with SOPs and regulatory guidelines, supporting adherence to industry standards
• Performed medical coding using MedDRA and WHO-DD
• Developed accurate narratives for safety reporting, enhancing clarity and understanding of safety issues

Utilized SCEPTRE system for data management