Santhu Hagulduty
Claim Analyst
Hyderabad,Telangana
Summary
Disciplined individual skilled in collecting and verifying patient demographic and insurance information and preparing and maintaining medical records. Proficient in using medical terminology and classifying diagnostic procedures, treatments and medications. Dedicated to providing highest quality care to patients.
Overview
5
5
years of professional experience
Work History
Claims Analyst
HOM - A Revenue Cycle Management Company
09.2023 - 04.2024
- Researched and resolved complex medical claims issues to support timely processing.
- Reviewing submitted claims and other documents, such as medical records or bills, to determine the eligibility of the claim for payment.
- Served as an expert resource for medical coding systems such as ICD-10, CPT.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Participated in cross-functional teams to develop strategies for improving overall department performance metrics.
Quality Control Reviewer
Releasepoint
03.2020 - 11.2022
- Proven knowledge and understanding of Medical Terminology.
- Examine the medical data retrieved has legible chart quality with correct patients details like Name, DOB, SSN, Address etc. and contain information requested as per client requirements.
- Worked on AWS and EPIC tools and prepared SOPs for the tool navigation.
- Expertise at analysis of different types of medical records like classifying the medical pages (Admission, Consultation, Referrals, Progress and Therapy notes) in EPIC tool, Laboratory Orders and Reports (MRI/XRAY/EMG/EKG), Operative and Surgery notes, Medication/Prescription and date stamping of medical pages.
- Analyzing and filling patient/client medical forms by reviewing EMR.
- Accurate Segregation of Document into Medical & Non-Medical pages (Fax Pages, Cover sheets, Medicare & Medicaid Insurance Claims) based on Client requirements.
- Medical reviewing of Billing Invoices - UB-04 and CMS 1500 Claim forms.
- Communicate issues to management in a timely manner.
Outpatient Coder
Medesun Healthcare Solutions
08.2019 - 02.2020
- Created and maintained up-to-date patient medical records to enable tracking history and preserve consistent information.
- Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
- Increased revenue for the facility by identifying and correcting undercoded services during chart reviews.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
Education
Bachelor of Science - Life Science
DR.B.R.AMBEDKAR UNIVERSITY
2019 04.2001 -
Skills
Timeline
Claims Analyst
HOM - A Revenue Cycle Management Company
09.2023 - 04.2024
Quality Control Reviewer
Releasepoint
03.2020 - 11.2022
Outpatient Coder
Medesun Healthcare Solutions
08.2019 - 02.2020
Bachelor of Science - Life Science
DR.B.R.AMBEDKAR UNIVERSITY
04.2001 -
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